Provider Demographics
NPI:1013009497
Name:NOURSE, ANN MORTON (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MORTON
Last Name:NOURSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 W TANEUM RD
Mailing Address - Street 2:
Mailing Address - City:THORP
Mailing Address - State:WA
Mailing Address - Zip Code:98946-9524
Mailing Address - Country:US
Mailing Address - Phone:509-964-2282
Mailing Address - Fax:
Practice Address - Street 1:590 PALM CANYON DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BORREGO SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92004-2013
Practice Address - Country:US
Practice Address - Phone:760-767-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18110261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT 18110AMedicare ID - Type UnspecifiedPHYSICAL THERAPIST