Provider Demographics
NPI:1316280589
Name:NORRIS, EMILY ROE ESTES (DPT)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ROE ESTES
Last Name:NORRIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:ROE
Other - Last Name:ESTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6010 LAKESIDE COMMONS DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210
Mailing Address - Country:US
Mailing Address - Phone:478-254-6880
Mailing Address - Fax:478-254-6883
Practice Address - Street 1:6010 LAKESIDE COMMONS DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-254-6880
Practice Address - Fax:478-254-6883
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT010243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT010243OtherSTATE LICENSE #