Provider Demographics
NPI:1346065612
Name:FALISH, MORGAN MEAZELL (PTA)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:MEAZELL
Last Name:FALISH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:ELISE
Other - Last Name:MEAZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 FORT CRAWFORD DR
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-6239
Mailing Address - Country:US
Mailing Address - Phone:903-241-1039
Mailing Address - Fax:
Practice Address - Street 1:311 E HAWKINS PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7942
Practice Address - Country:US
Practice Address - Phone:903-663-1079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2169600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant