=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417158783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAD ANDREW NORTON P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16030 VENTURA BLVD SUITE 400
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-986-8822
-----------------------------------------------------
Fax | 818-986-8222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 146 GREENMEADOW AVE
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91320-4137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-376-3043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT21547
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------