1588094650 NPI number — MORGAN LAY PT

Table of content: MORGAN LAY PT (NPI 1588094650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588094650 NPI number — MORGAN LAY PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAY
Provider First Name:
MORGAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588094650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
475 N HIGHWAY 25 W STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40769-1576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-825-0086
Provider Business Mailing Address Fax Number:
606-703-0134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 N HWY. SUITE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40769-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-825-0086
Provider Business Practice Location Address Fax Number:
606-703-0134
Provider Enumeration Date:
11/26/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  9852 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 006257 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)