Provider Demographics
NPI:1699277665
Name:MORGAN, NIKKI (PTA)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 WILEY BLVD SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-2364
Mailing Address - Country:US
Mailing Address - Phone:319-369-4340
Mailing Address - Fax:319-887-4955
Practice Address - Street 1:2230 WILEY BLVD SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-2364
Practice Address - Country:US
Practice Address - Phone:319-369-4340
Practice Address - Fax:319-887-4955
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01157225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant