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General NPI Number Information
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NPI Number | 1215311865
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Entity Type | Individual
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Provider Name | JESSICA DAWN HARRIS PTA
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Gender | Female
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 1926 RIDGE AVENUE
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City | WARREN
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State | OH
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Zip | 44484
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Country | US
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Telephone | 330-369-4672
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Fax | 330-369-2367
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Provider Business Mailing Address
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Address Line | 378 NORTH LUNDY AVE
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City | SALEM
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State | OH
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Zip | 44460
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Country | US
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Telephone | 330-831-4422
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA09711
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License Number State | OH
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