Provider Demographics
NPI:1396757274
Name:NORRIS, CHANCELLOR B (DPT)
Entity type:Individual
Prefix:
First Name:CHANCELLOR
Middle Name:B
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 1:200 E FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2336
Mailing Address - Country:US
Mailing Address - Phone:360-804-2604
Mailing Address - Fax:360-804-2569
Practice Address - Street 1:3900 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5033
Practice Address - Country:US
Practice Address - Phone:425-385-7352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8861577Medicare PIN