MEDICARE: MRS. EMILY FORD NORMAN LPTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2529	NC

General Provider Information

NPI Number	:	1376709378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY FORD NORMAN LPTA

Provider Business Mailing Address
First Line	:	195 THORNECLIFFE DR.
Second Line	:
City	:	STATE ROAD
State	:	NC
Zip	:	28676
Country	:	US
Telephone Number	:	336-874-2052
Fax Number	:	336-874-2052

Provider Business Practice Location Address
First Line	:	195 THORNECLIFFE DR.
Second Line	:
City	:	STATE ROAD
State	:	NC
Zip	:	28676
Country	:	US
Telephone Number	:	336-874-2052
Fax Number	:	336-874-2052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	07/30/2008

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