MEDICARE: STEPHEN RAY HARRIS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P9329	NC

General Provider Information

NPI Number	:	1043269889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN RAY HARRIS PT

Provider Business Mailing Address
First Line	:	4005 VILLAGE PARK DR
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-7044
Country	:	US
Telephone Number	:	919-570-7080
Fax Number	:	919-570-7081

Provider Business Practice Location Address
First Line	:	4005 VILLAGE PARK DR
Second Line	:
City	:	KNIGHTDALE
State	:	NC
Zip	:	27545-7044
Country	:	US
Telephone Number	:	919-217-0113
Fax Number	:	919-217-0059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	11/14/2025

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