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General NPI Number Information
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NPI Number | 1558978742
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Entity Type | Individual
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Provider Name | NORRIS CLARK III
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Gender | Male
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 6333 E MOCKINGBIRD LN STE 139
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City | DALLAS
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State | TX
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Zip | 75214-2376
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Country | US
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Telephone | 469-872-7473
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Fax | 469-466-1505
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Provider Business Mailing Address
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Address Line | 2001 BUTTERFIELD RD STE 1600
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13079
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License Number State | TN
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