Provider Demographics
NPI:1528096930
Name:MORRIS, TINA (PT)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:MORRIS
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 1:4712 NW 119TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3542
Mailing Address - Country:US
Mailing Address - Phone:954-232-7265
Mailing Address - Fax:954-575-0108
Practice Address - Street 1:4712 NW 119TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3542
Practice Address - Country:US
Practice Address - Phone:954-232-7265
Practice Address - Fax:954-575-0108
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 16564251E00000X, 222Q00000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889181800Medicaid