Provider Demographics
NPI:1538144084
Name:NORRIS, GREGORY B (PT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:B
Last Name:NORRIS
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 1:300 TWINING ST BLDG 760
Mailing Address - Street 2:
Mailing Address - City:MAXWELL AFB
Mailing Address - State:AL
Mailing Address - Zip Code:36112-6027
Mailing Address - Country:US
Mailing Address - Phone:334-953-3368
Mailing Address - Fax:334-953-8607
Practice Address - Street 1:300 TWINING ST BLDG 760
Practice Address - Street 2:
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6027
Practice Address - Country:US
Practice Address - Phone:334-953-3368
Practice Address - Fax:334-953-8670
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY900VOtherBLUE SHIELD
FLY900TOtherBLUE SHIELD
FLY900UOtherBLUE SHIELD
FLY900TOtherBLUE SHIELD
P00078220Medicare ID - Type UnspecifiedRAIL ROAD