Provider Demographics
NPI:1134758527
Name:NORRIS, MECHELLE SUEZETTE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MECHELLE
Middle Name:SUEZETTE
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 QUEST CT
Mailing Address - Street 2:
Mailing Address - City:DALE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22193
Mailing Address - Country:US
Mailing Address - Phone:703-980-5117
Mailing Address - Fax:
Practice Address - Street 1:LOYOLA UNIVERSITY MARYLAND ATHLETICS
Practice Address - Street 2:4501 N CHARLES ST.
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210
Practice Address - Country:US
Practice Address - Phone:410-617-5276
Practice Address - Fax:410-617-5709
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00010342081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine