MEDICARE: MRS. KRISTIN DAVIS HARRIS MPT

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	2251X0800X	Orthopedic Physical Therapist	P10820	NC
2	225100000X	Physical Therapist	P10820	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0676K	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1548350234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN DAVIS HARRIS MPT

Provider Business Mailing Address
First Line	:	1030 SIENA DR STE 120
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2781
Country	:	US
Telephone Number	:	919-232-5020
Fax Number	:	919-341-3323

Provider Business Practice Location Address
First Line	:	1030 SIENA DR STE 120
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2781
Country	:	US
Telephone Number	:	919-232-5020
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	01/10/2025

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