Provider Demographics
NPI:1679343552
Name:MORRIS, MONICA ANTOINETTE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ANTOINETTE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 S REVERE CV APT 101
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8697
Mailing Address - Country:US
Mailing Address - Phone:757-672-2007
Mailing Address - Fax:
Practice Address - Street 1:150 BW THOMAS DR STE 113
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-7240
Practice Address - Country:US
Practice Address - Phone:803-320-6134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11868225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist