Provider Demographics
NPI:1164246625
Name:PENN, MORGAN (PT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:PENN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14980 SW SCHOLLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8292
Mailing Address - Country:US
Mailing Address - Phone:503-926-4209
Mailing Address - Fax:503-294-7405
Practice Address - Street 1:511 SW 10TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2700
Practice Address - Country:US
Practice Address - Phone:503-294-7463
Practice Address - Fax:503-294-7405
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist