Provider Demographics
NPI:1265637730
Name:NORRIS, MICHAEL RENO (PTA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RENO
Last Name:NORRIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:4800 LITTLE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5900
Mailing Address - Country:US
Mailing Address - Phone:919-787-4072
Mailing Address - Fax:336-599-4030
Practice Address - Street 1:901 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4511
Practice Address - Country:US
Practice Address - Phone:336-599-4030
Practice Address - Fax:336-599-4030
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2949225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant