=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831423706
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN LYNN NORRIS PHYSICAL THERAPIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2009
-----------------------------------------------------
Last Update Date | 06/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 STAHLHUT DR
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62656-5066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-605-5500
-----------------------------------------------------
Fax | 217-732-3101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 STAHLHUT DR
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62656-5066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-605-5500
-----------------------------------------------------
Fax | 217-732-3101
-----------------------------------------------------
=====================================================
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 | 070001310
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1018924
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------