Provider Demographics
NPI:1316657695
Name:JOHANSEN, MORGAN TAYLOR (PT)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:TAYLOR
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55930 BLUE EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707-2369
Mailing Address - Country:US
Mailing Address - Phone:541-640-2518
Mailing Address - Fax:541-550-2919
Practice Address - Street 1:55930 BLUE EAGLE RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97707-2369
Practice Address - Country:US
Practice Address - Phone:541-640-2518
Practice Address - Fax:541-550-2919
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist