Provider Demographics
NPI:1871870618
Name:MORGAN, JOHN (LMT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 PROFESSIONAL DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3949
Mailing Address - Country:US
Mailing Address - Phone:406-586-9978
Mailing Address - Fax:
Practice Address - Street 1:607 PROFESSIONAL DR
Practice Address - Street 2:SUITE #2
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3949
Practice Address - Country:US
Practice Address - Phone:406-586-9978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist