MEDICARE: MRS. LOIS MAY HARRISON 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	842	NC

General Provider Information

NPI Number	:	1629052907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOIS MAY HARRISON PT

Provider Business Mailing Address
First Line	:	3500 MOUNT HOLLY HUNTERSVILLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-8644
Country	:	US
Telephone Number	:	704-399-7800
Fax Number	:	704-399-7717

Provider Business Practice Location Address
First Line	:	3500 MOUNT HOLLY HUNTERSVILLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-8644
Country	:	US
Telephone Number	:	704-399-7800
Fax Number	:	704-399-7717

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	07/12/2007

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