Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-3496 | ID |
NPI | 1003227406 |
---|---|
Provider Name | Dr. Greg Carl Norris |
First Address | Hansen, ID 83334-5059 |
Second Address | Hansen, ID 83334-5059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2014 |
Last Update Date | 20/05/2014 |