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NPI Code Detail

MEDICARE: MRS. PATTI KELLETT HARLAN PTA

MEDICARE: MRS. PATTI KELLETT HARLAN PTA
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
1225200000XPhysical Therapy Assistant1699SC

General Provider Information

NPI Number : 1649352584
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PATTI KELLETT HARLAN PTA
Provider Business Mailing Address
First Line : 5170 NORTH LAURENS RD
Second Line :
City : GRAY COURT
State : SC
Zip : 29645
Country : US
Telephone Number : 864-444-0580
Fax Number :
Provider Business Practice Location Address
First Line : 125 COMMONWEALTH DR
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-4812
Country : US
Telephone Number : 864-675-4393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 07/08/2007

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