Provider Demographics
NPI:1831160084
Name:JESSE, NORRIS FRED II (PT)
Entity type:Individual
Prefix:
First Name:NORRIS
Middle Name:FRED
Last Name:JESSE
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 BURR RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6106
Mailing Address - Country:US
Mailing Address - Phone:210-828-3946
Mailing Address - Fax:210-916-4074
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:BROKKE ARMY MEDICAL CENTER, AMPUTEE PHYSICAL THERAPY
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-916-5048
Practice Address - Fax:210-916-4074
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist