MEDICARE: MISS GEORGIA LYNN NORGREN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	7050	CO

General Provider Information

NPI Number	:	1053400192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GEORGIA LYNN NORGREN DPT

Provider Business Mailing Address
First Line	:	PO BOX 283
Second Line	:
City	:	WINTER PARK
State	:	CO
Zip	:	80482-0283
Country	:	US
Telephone Number	:	303-726-9805
Fax Number	:

Provider Business Practice Location Address
First Line	:	554 BAKER DRIVE
Second Line	:
City	:	WINTER PARK
State	:	CO
Zip	:	80482-0283
Country	:	US
Telephone Number	:	303-726-9805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	04/08/2014

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