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General NPI Number Information
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NPI Number | 1235761719
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Entity Type | Individual
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Provider Name | SUZANNE ELIZABETH HARRIS LAT, ATC, CEAS
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Gender | Female
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 17230 US HIGHWAY 17 N STE 218
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City | HAMPSTEAD
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State | NC
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Zip | 28443-7466
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Country | US
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Telephone | 910-821-1506
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Fax | 910-821-1508
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Provider Business Mailing Address
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Address Line | 502 PLUM NEARLY LN APT K
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City | WILMINGTON
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State | NC
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Zip | 28403-2759
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Country | US
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Telephone | 717-926-4689
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 006752
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 4291
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License Number State | NC
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