Healthcare Provider Details

I. General information

NPI: 1942252663
Provider Name (Legal Business Name): SANDRA DIANE NORLIN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7743 GRAND RIVER RD #100
BRIGHTON MI
48114-7393
US

IV. Provider business mailing address

650 PLEASANT VALLEY
MILFORD MI
48380-2618
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-3588
  • Fax:
Mailing address:
  • Phone: 248-684-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501001382
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: