Provider Demographics
NPI:1427122860
Name:MORGAN, TREVA R (LMP)
Entity type:Individual
Prefix:
First Name:TREVA
Middle Name:R
Last Name:MORGAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 NE 87TH AVE.
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6831
Mailing Address - Country:US
Mailing Address - Phone:360-909-4883
Mailing Address - Fax:
Practice Address - Street 1:1300 ESTHER ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2889
Practice Address - Country:US
Practice Address - Phone:360-909-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-18
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist