Basic Information
Provider Information
NPI: 1487036935
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NORBO
FirstName: CARTER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 110 MINOR RD
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229031717
CountryCode: US
TelephoneNumber: 4348177848
FaxNumber: 4349512194
Practice Location
Address1: 504 ALBEMARLE SQ
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229017405
CountryCode: US
TelephoneNumber: 4348177848
FaxNumber: 4349512194
Other Information
ProviderEnumerationDate: 06/22/2015
LastUpdateDate: 06/22/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X2305209568VAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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