Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA 11129 | FL |
NPI | 1003067687 |
---|---|
Provider Name | Mr. Thomas W. Morgan |
First Address | Gulf Breeze, FL 32561-7807 |
Second Address | Pensacola, FL 32506-5939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 01/10/2008 |