Provider Demographics
NPI:1740200690
Name:NORRIS, DANA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:L
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:5300 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-3500
Mailing Address - Country:US
Mailing Address - Phone:618-222-2222
Mailing Address - Fax:618-222-2228
Practice Address - Street 1:5300 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-3500
Practice Address - Country:US
Practice Address - Phone:618-222-2222
Practice Address - Fax:618-222-2228
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist