Healthcare Provider Details

I. General information

NPI: 1134552458
Provider Name (Legal Business Name): WILLIAM SCOTT NORRIS LICENSED MASSAGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2013
Last Update Date: 08/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 DON GASPAR AVE
SANTA FE NM
87505-2626
US

IV. Provider business mailing address

1000 CORDOVA PL # 101
SANTA FE NM
87505-1725
US

V. Phone/Fax

Practice location:
  • Phone: 505-670-2927
  • Fax:
Mailing address:
  • Phone: 505-670-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3006
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: