Provider Demographics
NPI:1447943113
Name:PHENIX, MORGAN SAVANNAH (DPT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:SAVANNAH
Last Name:PHENIX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 S STATE ST UNIT 1601
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3581
Mailing Address - Country:US
Mailing Address - Phone:573-263-4031
Mailing Address - Fax:
Practice Address - Street 1:8434 CORCORAN RD
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60480-1666
Practice Address - Country:US
Practice Address - Phone:708-467-0657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070027482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist