Healthcare Provider Details

I. General information

NPI: 1346661725
Provider Name (Legal Business Name): HEIDI HARRIS BS,R.T.K.,D.T.S.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BRENNER AVE
SALISBURY NC
28144-2515
US

IV. Provider business mailing address

1601 BRENNER AVE
SALISBURY NC
28144-2515
US

V. Phone/Fax

Practice location:
  • Phone: 704-638-9000
  • Fax: 704-638-3811
Mailing address:
  • Phone: 704-638-9000
  • Fax: 704-638-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number1910
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: