Provider Demographics
NPI:1528091543
Name:MORRISSEY, LENORE FILLER (MPT, DPT, OCS, CFC)
Entity type:Individual
Prefix:MRS
First Name:LENORE
Middle Name:FILLER
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:MPT, DPT, OCS, CFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140535
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-0535
Mailing Address - Country:US
Mailing Address - Phone:208-353-3184
Mailing Address - Fax:
Practice Address - Street 1:8601 W EMERALD ST STE 176
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8297
Practice Address - Country:US
Practice Address - Phone:208-353-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245202251X0800X
IDPT-84272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11585418OtherCAQH
CAW19563Medicare ID - Type Unspecified