MEDICARE: PAIGE HARRIS DPT

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	3125349	TX

General Provider Information

NPI Number	:	1154945764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE HARRIS DPT

Provider Business Mailing Address
First Line	:	107 CANYON LOOKOUT LN
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78633-2063
Country	:	US
Telephone Number	:	512-818-9274
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 BRODIE LN STE C8
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5005
Country	:	US
Telephone Number	:	512-712-4192
Fax Number	:

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

Provider Enumeration Date	:	05/31/2020
Last Update Date	:	05/31/2020

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