Provider Demographics
NPI:1831895515
Name:NORRIS, LINCOLN
Entity type:Individual
Prefix:
First Name:LINCOLN
Middle Name:
Last Name:NORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 BLUEWATER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3888
Mailing Address - Country:US
Mailing Address - Phone:850-897-3334
Mailing Address - Fax:850-279-6660
Practice Address - Street 1:1950 BLUEWATER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3888
Practice Address - Country:US
Practice Address - Phone:850-897-3334
Practice Address - Fax:850-279-6660
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist