Provider Demographics
NPI:1609019850
Name:MORGAN, GLORIA JEANNE (LMP)
Entity type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:JEANNE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:JEANNE
Other - Last Name:BATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:5521 186TH PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4325
Mailing Address - Country:US
Mailing Address - Phone:425-776-3000
Mailing Address - Fax:
Practice Address - Street 1:5521 186TH PL SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4325
Practice Address - Country:US
Practice Address - Phone:425-776-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019084225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist