Basic Information
| Provider Information | |||||||||
| NPI: | 1043710452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORGAN | ||||||||
| FirstName: | LANDAN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 540640 | ||||||||
| Address2: | |||||||||
| City: | NORTH SALT LAKE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840540640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019878700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1050 W ELM AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | HERMISTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978382713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415675678 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2018 | ||||||||
| LastUpdateDate: | 02/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.