Provider Demographics
NPI:1356711543
Name:NORRIS, STEFAN JAMES (DPT)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:JAMES
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 1:726 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-3619
Mailing Address - Country:US
Mailing Address - Phone:337-565-4355
Mailing Address - Fax:337-565-4357
Practice Address - Street 1:726 VETERANS DR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-3619
Practice Address - Country:US
Practice Address - Phone:337-565-4355
Practice Address - Fax:337-565-4357
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA09171OtherLA PHYSICAL THERAPY BOARD LICENSE NUMBER