Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 00436 | MO |
NPI | 1396070397 |
---|---|
Provider Name | Rosemary Archambault Norris |
First Address | Saint Louis, MO 63104-1111 |
Second Address | Saint Louis, MO 63104-1111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2009 |
Last Update Date | 08/10/2009 |