Provider Demographics
NPI:1225240559
Name:FORTT, NORMAN LEE (PTA)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:LEE
Last Name:FORTT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 KENTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5278
Mailing Address - Country:US
Mailing Address - Phone:302-674-3114
Mailing Address - Fax:
Practice Address - Street 1:415 MARKET ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3301
Practice Address - Country:US
Practice Address - Phone:410-939-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3047225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant