MEDICARE: SIERRA HARRIS

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	225200000X	Physical Therapy Assistant	PTA7599	MS

General Provider Information

NPI Number	:	1629845243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA HARRIS

Provider Business Mailing Address
First Line	:	2120 PRINCE GEORGE DR
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-3837
Country	:	US
Telephone Number	:	228-271-5491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 PRINCE GEORGE DR
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-3837
Country	:	US
Telephone Number	:	228-271-5491
Fax Number	:

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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Directions to “ SIERRA HARRIS ” Practice Location

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