Provider Demographics
NPI:1992947139
Name:HARBISON, ELIZABETH MARTIN (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARTIN
Last Name:HARBISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SMELIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:203 SPICER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:28445-8902
Mailing Address - Country:US
Mailing Address - Phone:910-409-7954
Mailing Address - Fax:
Practice Address - Street 1:6626 GORDON RD STE H
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8424
Practice Address - Country:US
Practice Address - Phone:910-233-0726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP2928225100000X
NC2928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1992947139OtherNATIONAL PROVIDER IDENTIFICATION
NCP2928OtherNORTH CAROLINA BOARD OF PHYSICAL THERAPY