Healthcare Provider Details

I. General information

NPI: 1295850873
Provider Name (Legal Business Name): TINA HARRIS PHYSICAL THERAPY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 N FRANKLIN AVE
COLBY KS
67701-2322
US

IV. Provider business mailing address

270 N FRANKLIN AVE
COLBY KS
67701-2322
US

V. Phone/Fax

Practice location:
  • Phone: 785-462-8008
  • Fax: 785-460-8080
Mailing address:
  • Phone: 785-462-8008
  • Fax: 785-460-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-2054
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1102054
License Number StateKS

VIII. Authorized Official

Name: TINA M HARRIS
Title or Position: ADMINISTRATOR
Credential: P.T.
Phone: 785-462-8008