Provider Demographics
NPI:1316168198
Name:HARRIS, VIRGINIA MARY (CAADAC II)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CAADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3869 MARY ANN LANE
Mailing Address - Street 2:
Mailing Address - City:LAKE ALMANOR
Mailing Address - State:CA
Mailing Address - Zip Code:96137
Mailing Address - Country:US
Mailing Address - Phone:596-852-7713
Mailing Address - Fax:
Practice Address - Street 1:555 HOSPITAL LANE
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130
Practice Address - Country:US
Practice Address - Phone:530-251-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner