MEDICARE: MARCELL HARRIS 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
1	225200000X	Physical Therapy Assistant	PTA003911	GA

General Provider Information

NPI Number	:	1649784455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELL HARRIS PTA

Provider Business Mailing Address
First Line	:	481 ELMA G MILES PKWY
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-4006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	481 ELMA G MILES PKWY
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-4006
Country	:	US
Telephone Number	:	912-368-1078
Fax Number	:

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

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	12/01/2017

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Directions to “ MARCELL HARRIS PTA” Practice Location

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