Provider Demographics
NPI:1881888246
Name:NORRIS, MARY C (PTA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:1423 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-5351
Mailing Address - Country:US
Mailing Address - Phone:269-323-4300
Mailing Address - Fax:269-323-4449
Practice Address - Street 1:1423 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5351
Practice Address - Country:US
Practice Address - Phone:269-323-4300
Practice Address - Fax:269-323-4449
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant