=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376789024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARRIS PHYSICAL THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2008
-----------------------------------------------------
Last Update Date | 12/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2603 MAIN DR SUITE 3
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72704-5278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-966-4883
-----------------------------------------------------
Fax | 479-445-6130
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2603 MAIN DR SUITE 3
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72704-5278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-966-4883
-----------------------------------------------------
Fax | 479-445-6130
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HANNAH HARRIS
-----------------------------------------------------
Credential | MPT
-----------------------------------------------------
Telephone | 479-966-4883
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------