Healthcare Provider Details

I. General information

NPI: 1942498100
Provider Name (Legal Business Name): JANET RUTH HARRIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 INTERNATIONAL PKWY #260
LAKE MARY FL
32746-5030
US

IV. Provider business mailing address

272 CAMBRIDGE RD APT. 2
WOBURN MA
01801-6007
US

V. Phone/Fax

Practice location:
  • Phone: 800-806-6026
  • Fax:
Mailing address:
  • Phone: 978-808-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: