MEDICARE: STACEY HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2305203610	OTHER	VA	LICENSE #

General Provider Information

NPI Number	:	1194831792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY HARRIS

Provider Business Mailing Address
First Line	:	5475 SURREY CT
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069
Country	:	US
Telephone Number	:	276-870-2221
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 RICHMOND HWY STE 100
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1850
Country	:	US
Telephone Number	:	703-765-7700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/09/2017

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Directions to “ STACEY HARRIS ” Practice Location

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