Provider Demographics
NPI:1558758250
Name:NORVILLE, CARMEN (DPT)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:NORVILLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S 3RD ST E
Mailing Address - Street 2:PO BOX 664
Mailing Address - City:MALTA
Mailing Address - State:MT
Mailing Address - Zip Code:59538-8728
Mailing Address - Country:US
Mailing Address - Phone:406-654-5231
Mailing Address - Fax:406-654-5241
Practice Address - Street 1:801 S 3RD ST E
Practice Address - Street 2:APT 1
Practice Address - City:MALTA
Practice Address - State:MT
Practice Address - Zip Code:59538-8728
Practice Address - Country:US
Practice Address - Phone:406-654-5231
Practice Address - Fax:406-654-5241
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011006338Medicare PIN