Provider Demographics
NPI:1285621292
Name:MORGAN, DALE K (RPT)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:K
Last Name:MORGAN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 HIGHWAY 82 W
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-5069
Mailing Address - Country:US
Mailing Address - Phone:662-455-5010
Mailing Address - Fax:662-455-5468
Practice Address - Street 1:702 HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-5069
Practice Address - Country:US
Practice Address - Phone:662-455-5010
Practice Address - Fax:662-455-5468
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT0413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05203821Medicaid