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General NPI Number Information
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NPI Number | 1629883343
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Entity Type | Individual
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Provider Name | AUTUMN HARLESS PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 3050 DOWLEN RD STE L
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City | BEAUMONT
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State | TX
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Zip | 77706-7285
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Country | US
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Telephone | 409-861-4606
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Fax |
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Provider Business Mailing Address
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Address Line | 7654 BOARDWALK
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City | LUMBERTON
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State | TX
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Zip | 77657-6987
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Country | US
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Telephone | 540-597-8108
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1403964
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License Number State | TX
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