Provider Demographics
NPI:1417139056
Name:PHYLLIS A. NORRIS
Entity Type:Organization
Organization Name:PHYLLIS A. NORRIS
Other - Org Name:THE SHOE BOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:863-763-4401
Mailing Address - Street 1:1138 S. PARROTT AVE.
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-6239
Mailing Address - Country:US
Mailing Address - Phone:863-763-4401
Mailing Address - Fax:863-763-6335
Practice Address - Street 1:1138 S PARROTT AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-5270
Practice Address - Country:US
Practice Address - Phone:863-763-4401
Practice Address - Fax:863-763-6335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4582560001Medicare NSC