Provider Demographics
NPI:1194782458
Name:HARRIS, STANLEY JENKINS (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:JENKINS
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 FAIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8009
Mailing Address - Country:US
Mailing Address - Phone:501-758-1300
Mailing Address - Fax:501-758-1316
Practice Address - Street 1:4801 FAIRWAY AVE
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8009
Practice Address - Country:US
Practice Address - Phone:501-758-1300
Practice Address - Fax:501-758-1316
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129283721Medicaid
AR5S488OtherBLUE CROSS BLUE SHIELD
AR5G468OtherMEDICARE GROUP
AR5S488Medicare UPIN