Provider Demographics
NPI:1386180008
Name:MORGAN, JACQUELINE (DPT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 COURTHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427-9336
Mailing Address - Country:US
Mailing Address - Phone:804-633-1232
Mailing Address - Fax:
Practice Address - Street 1:121 COURTHOUSE LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427-9336
Practice Address - Country:US
Practice Address - Phone:804-633-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist