Provider Demographics
NPI:1215923263
Name:NORMAN, JAMES M (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:NORMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:240 N BLUFF BLVD SUITE 101
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0337
Mailing Address - Country:US
Mailing Address - Phone:563-519-0242
Mailing Address - Fax:563-241-4353
Practice Address - Street 1:931 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5070
Practice Address - Country:US
Practice Address - Phone:563-243-7814
Practice Address - Fax:563-243-2441
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19401625225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0117879Medicaid
R03164Medicare UPIN
IA0117879Medicaid