Basic Information
| Provider Information | |||||||||
| NPI: | 1578508107 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORMINGTON | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | DEAN | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13164 HUNTERCREEK RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | DES PERES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312231 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 880 COLUMBIA CTR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622362567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182819397 | ||||||||
| FaxNumber: | 6182819698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.