Provider Demographics
NPI:1134439250
Name:JORIS, MARIE LOUISE (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:LOUISE
Last Name:JORIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 CHEMIN DE MORMAL
Mailing Address - Street 2:
Mailing Address - City:MECQUIGNIES
Mailing Address - State:FRANCE
Mailing Address - Zip Code:59570
Mailing Address - Country:FR
Mailing Address - Phone:003332-763-8286
Mailing Address - Fax:
Practice Address - Street 1:UNIT 21414 BOX 3530
Practice Address - Street 2:SHAPE HEALTHCARE FACILITY
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09705-1414
Practice Address - Country:US
Practice Address - Phone:00326-544-5892
Practice Address - Fax:00326-544-5919
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ51022790512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist