Provider Demographics
NPI:1548278047
Name:NORRIS, JACQUELINE A (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:A
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MARINA DR
Mailing Address - Street 2:UNIT E-4
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1677
Mailing Address - Country:US
Mailing Address - Phone:845-879-9288
Mailing Address - Fax:
Practice Address - Street 1:185 ROUTE 312 STE 301B
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2338
Practice Address - Country:US
Practice Address - Phone:845-279-9288
Practice Address - Fax:845-279-7701
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024474-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSR5812761Medicare ID - Type Unspecified