Basic Information
| Provider Information | |||||||||
| NPI: | 1497217749 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORTON | ||||||||
| FirstName: | LAURICE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 ASSEMBLY DR UNIT 211 | ||||||||
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| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281175420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049528325 | ||||||||
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| Practice Location | |||||||||
| Address1: | 136 CORPORATE PARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281176960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043602796 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2019 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P13864 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.