Provider Demographics
NPI:1336517622
Name:NORRIS, MARVISHA (PTA)
Entity Type:Individual
Prefix:
First Name:MARVISHA
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7848 TAYLOR PARK RD APT B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4766
Mailing Address - Country:US
Mailing Address - Phone:256-794-3382
Mailing Address - Fax:
Practice Address - Street 1:7848 TAYLOR PARK RD APT B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4766
Practice Address - Country:US
Practice Address - Phone:256-794-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA31114225200000X
ALPTA 5657225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant