Provider Demographics
NPI:1063578193
Name:HARRIS, PAMELA A (PT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1802
Mailing Address - Country:US
Mailing Address - Phone:317-691-6486
Mailing Address - Fax:317-883-4815
Practice Address - Street 1:651 BROOKVIEW DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1802
Practice Address - Country:US
Practice Address - Phone:317-691-6486
Practice Address - Fax:317-883-4815
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005045A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist