Individual
MORGAN ALEXANDRA BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
4833 HIGHWAY 58, CHATTANOOGA, TN 37416-1826
(423) 553-7972
(423) 553-7973
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-8907
(423) 954-7408
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10117
TN
225100000X
Physical Therapist
PT011693
GA
225100000X
Physical Therapist
PTH7299
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002422
OPTUM
—
01
—
102I652175
MEDICARE PTAN
AL
01
—
511-54895
BCBS-ATHENS
AL
01
—
511-54896
BCBS-HOOVER
AL
01
—
511-54897
BCBS-CHELSEA
AL
01
—
511-54898
BCBS-MOODY
AL
01
—
511-54899
BCBS-WEST MADISON
AL
01
—
511-56409
BCBS-ALTADENA
AL
Enumeration date
08/07/2014
Last updated
12/12/2016
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