Basic Information
| Provider Information | |||||||||
| NPI: | 1518687169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | JEVON | ||||||||
| MiddleName: | ANDRES | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5105 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049155100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192205255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11550 COMMON OAKS DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276148093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194535740 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2022 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | P21561 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | P21561 | 01 | NC | PT LICENSE | OTHER |