Provider Demographics
NPI:1962516534
Name:MORGAN, MARTHA (MSPT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LAWLER RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2131
Mailing Address - Country:US
Mailing Address - Phone:781-483-9732
Mailing Address - Fax:
Practice Address - Street 1:653 SUMMER ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-2108
Practice Address - Country:US
Practice Address - Phone:617-269-6262
Practice Address - Fax:617-269-1068
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68220OtherBLUE CROSS BLUE SHIELD
MA6440025OtherUNITED HEALTH PLAN
MA603413OtherHARVARD PILGRIM
MA8211OtherNEIGHBORHOOD HEALTH PLAN
MA470119OtherTUFTS HEALTH PLAN
MA6440025OtherUNITED HEALTH PLAN