Healthcare Provider Details

I. General information

NPI: 1629397484
Provider Name (Legal Business Name): HEATHER ANNE HARRISON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ANNE STEVENS DPT

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W MALLARD CREEK CHURCH RD SUITE 180
CHARLOTTE NC
28262-2324
US

IV. Provider business mailing address

4601 PARK RD SUITE 300
CHARLOTTE NC
28209-3239
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-2108
  • Fax: 704-323-2199
Mailing address:
  • Phone: 704-323-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11170
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: