Healthcare Provider Details

I. General information

NPI: 1396070397
Provider Name (Legal Business Name): ROSEMARY ARCHAMBAULT NORRIS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3437 CAROLINE ST ROOM 1026
SAINT LOUIS MO
63104-1111
US

IV. Provider business mailing address

3437 CAROLINE ST ROOM 1026
SAINT LOUIS MO
63104-1111
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-8533
  • Fax: 314-977-8513
Mailing address:
  • Phone: 314-977-8533
  • Fax: 314-977-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number00436
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: