Provider Demographics
NPI:1659417368
Name:NORMAN, MAURA R (LMT)
Entity Type:Individual
Prefix:MS
First Name:MAURA
Middle Name:R
Last Name:NORMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MAURA
Other - Middle Name:R
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3625 N COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 2110
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1729
Mailing Address - Country:US
Mailing Address - Phone:305-962-3668
Mailing Address - Fax:954-963-7169
Practice Address - Street 1:3625 N COUNTRY CLUB DR
Practice Address - Street 2:SUITE 2110
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1729
Practice Address - Country:US
Practice Address - Phone:305-962-3668
Practice Address - Fax:954-963-7169
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA23723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC8120OtherBLUE CROSS BLUE SHEILD