Provider Demographics
NPI:1417158783
Name:NORTON, TAD ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:TAD
Middle Name:ANDREW
Last Name:NORTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 GREENMEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4137
Mailing Address - Country:US
Mailing Address - Phone:805-376-3043
Mailing Address - Fax:
Practice Address - Street 1:16030 VENTURA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2731
Practice Address - Country:US
Practice Address - Phone:818-986-8822
Practice Address - Fax:818-986-8222
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist