Mark Rory Norville

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

40QB00410300 Issued in NJ

Practice address

125 Washington Valley Rd Ste 3
Warren, NJ 07059-7179

Phone

(908) 741-8404

NPI assigned

Oct 4, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696377600000",
    "number": "1962282186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "468 MORRIS AVE APT 3",
            "city": "SUMMIT",
            "state": "NJ",
            "postal_code": "079017504",
            "telephone_number": "856-503-8825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 WASHINGTON VALLEY RD STE 3",
            "city": "WARREN",
            "state": "NJ",
            "postal_code": "070597179",
            "telephone_number": "908-741-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORVILLE",
        "first_name": "MARK",
        "middle_name": "RORY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-10-04",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "NJ",
            "license": "40QB00410300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Timothy Olson
• Optical Associates, LLC

• Physical Therapy Assistant in Warren, NJ
• Providers in Warren, NJ by specialty
• Physical Therapy Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.