Basic Information
Provider Information | |||||||||
NPI: | 1558995142 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRUTCHFIELD | ||||||||
FirstName: | MORGAN | ||||||||
MiddleName: | SHEA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | STERKER | ||||||||
OtherFirstName: | MORGAN | ||||||||
OtherMiddleName: | SHEA | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1497 GREYFIELD DR | ||||||||
Address2: |   | ||||||||
City: | SAINT AUGUSTINE | ||||||||
State: | FL | ||||||||
PostalCode: | 320925019 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3522563496 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1000 W BROADWAY ST STE 214 | ||||||||
Address2: |   | ||||||||
City: | OVIEDO | ||||||||
State: | FL | ||||||||
PostalCode: | 327659262 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4073595693 | ||||||||
FaxNumber: | 4077925693 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/24/2020 | ||||||||
LastUpdateDate: | 02/24/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/24/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT27306 | FL | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.