Healthcare Provider Details

I. General information

NPI: 1821113051
Provider Name (Legal Business Name): CAROL NORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WOODLAND AVE
PLAINFIELD NJ
07060-3362
US

IV. Provider business mailing address

421 BAKER AVE
WESTFIELD NJ
07090-1960
US

V. Phone/Fax

Practice location:
  • Phone: 908-753-1113
  • Fax: 908-753-9558
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number40QB00166600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: