Provider Demographics
NPI:1174789713
Name:MORRIS, KENNETH C (PT, DPT, CMTPT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PT, DPT, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:12494 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3000
Practice Address - Country:US
Practice Address - Phone:757-599-5551
Practice Address - Fax:757-595-5238
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00637360OtherRAILROAD MEDICARE
VA192931OtherBCBS PHYSICAL THERAPY
VA1174789713Medicaid
VA9869210OtherAETNA
VAMC10848Medicare PIN
VA192931OtherBCBS PHYSICAL THERAPY