Healthcare Provider Details

I. General information

NPI: 1275455792
Provider Name (Legal Business Name): ISABELLA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IZZY HARRIS

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 RICHARDSON ST APT 4402
CAYCE SC
29033-4440
US

IV. Provider business mailing address

225 RICHARDSON ST APT 4402
CAYCE SC
29033-4440
US

V. Phone/Fax

Practice location:
  • Phone: 802-355-9303
  • Fax:
Mailing address:
  • Phone: 802-355-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: