Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | CA-PT30002 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT30002 | CA |
NPI | 1043396294 |
---|---|
Provider Name | Mr. Philip Andrew Morrow |
First Address | Fresno, CA 93720-4833 |
Second Address | Fresno, CA 93720-4833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0PT300020 | BLUE SHIELD (01) | CA |