Individual provider Active NPI

Chancellor B Norris, DPT

  • Physical Therapist
  • Everett, WA
National Provider Identifier
1396757274
Registry record updated Jun 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00010228 Issued in WA
Practice address
3900 Broadway
Everett, WA 98201-5033
Phone
(425) 385-7352
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00010228 WA Primary

Addresses

Primary practice location

3900 Broadway
Everett, WA 98201-5033

Mailing address

200 E Fremont St
Monroe, WA 98272-2336
Phone (360) 804-2604

Other practice location 1

1819 S Lake Stevens Rd Unit E
Lake Stevens, WA 98258-2060
Phone (425) 334-1122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061004000185 WA Practitioner - Physical Therapist in Private Practice 3173529765 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
NSPT IncGroup PAC ID 5698850295, 26 clinicians

Practice addresses (Care Compare)

27500 102ND Ave NW
Suite 1
Stanwood, WA 98292-8092
Phone (360) 629-9768

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT00010228WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
NSPT, Inc. Physical Therapist CurrentSince Jun 19, 2023 Accepting new patients
NSPT, Inc. Physical Therapist CurrentSince Jun 19, 2023 Accepting new patients

Locations

1819 S Lake Stevens Rd
Unit E
Lake Stevens, WA 98258
Phone (425) 334-1122

4420 106th St SW
Mukilteo, WA 98275
Phone (425) 212-1810

27500 102nd Ave NW
Ste 1
Stanwood, WA 98292
Phone (360) 629-7528

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1396757274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E FREMONT ST",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982722336",
            "telephone_number": "360-804-2604",
            "fax_number": "360-804-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 BROADWAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982015033",
            "telephone_number": "425-385-7352"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1819 S Lake Stevens Rd Unit E",
            "address_purpose": "LOCATION",
            "city": "Lake Stevens",
            "state": "WA",
            "postal_code": "982582060",
            "country_code": "US",
            "telephone_number": "425-334-1122",
            "fax_number": "425-334-1188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NORRIS",
        "first_name": "CHANCELLOR",
        "middle_name": "B",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00010228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.