Provider Demographics
NPI:1154886521
Name:DEPLANTY, MORGAN ELIZABETH (ATC, LAT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:ELIZABETH
Last Name:DEPLANTY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 E 625 N
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IN
Mailing Address - Zip Code:47859-8885
Mailing Address - Country:US
Mailing Address - Phone:765-592-2889
Mailing Address - Fax:
Practice Address - Street 1:215 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-438-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960044992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL096004499OtherLICENSED ATHLETIC TRAINER