Healthcare Provider Details

I. General information

NPI: 1376211045
Provider Name (Legal Business Name): KASSIDY JACKLYN HARRIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HARRIS RD
NASHUA NH
03062-2145
US

IV. Provider business mailing address

33 ROYAL CREST DR APT 4
NASHUA NH
03060-5434
US

V. Phone/Fax

Practice location:
  • Phone: 603-888-1573
  • Fax:
Mailing address:
  • Phone: 860-334-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4878
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: