Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT8449 | CA |
NPI | 1205193125 |
---|---|
Provider Name | Jacalyn D. Harris |
First Address | Berkeley, CA 94705-1360 |
Second Address | Berkeley, CA 94705-1360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2012 |
Last Update Date | 18/04/2012 |