Provider Demographics
NPI:1124638101
Name:HARRIS-MANIER, JENNIFER R (PTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:HARRIS-MANIER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 POSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-1289
Mailing Address - Country:US
Mailing Address - Phone:254-675-7955
Mailing Address - Fax:
Practice Address - Street 1:101 POSEY AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1289
Practice Address - Country:US
Practice Address - Phone:254-675-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2040913225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant