MEDICARE: MRS. JACQUELINE A NORRIS PHYSICAL THERAPIST

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	225100000X	Physical Therapist	024474-1	NY

General Provider Information

NPI Number	:	1548278047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE A NORRIS PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	4 MARINA DR
Second Line	:	UNIT E-4
City	:	MAHOPAC
State	:	NY
Zip	:	10541-1677
Country	:	US
Telephone Number	:	845-879-9288
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 ROUTE 312 STE 301B
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-2338
Country	:	US
Telephone Number	:	845-279-9288
Fax Number	:	845-279-7701

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	03/02/2012

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