Provider Demographics
NPI:1942749452
Name:NORRIS, MATTHEW BOYD (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BOYD
Last Name:NORRIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 MEBANE OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7951
Mailing Address - Country:US
Mailing Address - Phone:919-563-1825
Mailing Address - Fax:919-563-1833
Practice Address - Street 1:3948 FOREST OAKS LN
Practice Address - Street 2:BLDG E
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-9813
Practice Address - Country:US
Practice Address - Phone:919-563-1133
Practice Address - Fax:919-304-9042
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG76041Medicaid
NCG76041Medicaid