Provider Demographics
NPI:1053561464
Name:MORGAN, WILLIAM DREW (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DREW
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2758
Mailing Address - Country:US
Mailing Address - Phone:479-968-2525
Mailing Address - Fax:479-968-2538
Practice Address - Street 1:3605 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7377
Practice Address - Country:US
Practice Address - Phone:501-327-2235
Practice Address - Fax:501-327-1601
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA002OtherTRICARE
AR5A963C556OtherBLUE CROSS BLUE SHIELD
ARP00685672OtherPALMETTO RR
AR175205721Medicaid
AR175205721Medicaid