Provider Demographics
NPI:1366810137
Name:SHORT, NORMA A (LMT, CMT, BCTMB)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:A
Last Name:SHORT
Suffix:
Gender:F
Credentials:LMT, CMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SEA ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6138
Mailing Address - Country:US
Mailing Address - Phone:843-815-7352
Mailing Address - Fax:843-815-7352
Practice Address - Street 1:2 SEA ISLAND DR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6138
Practice Address - Country:US
Practice Address - Phone:843-815-7352
Practice Address - Fax:843-815-7352
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4576225700000X
VA0019005686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist