Individual
MARK MORGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
221 S RIVER ST, HAILEY, ID 83333-8436
(208) 788-0061
(208) 788-2211
Mailing address
PO BOX 1191, HAILEY, ID 83333-1191
(208) 788-0061
(208) 788-2211
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT-647
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010025485
BLUE SHIELD PROVIDER NUM.
ID
05
—
805397000
—
ID
01
—
P00060576
RAILROAD MEDICARE NUMBER
ID
01
—
T6251
BLUE CROSS PROVIDER NUM.
ID
Enumeration date
04/26/2007
Last updated
12/03/2011
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