Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 29381 | FL |
N | 2251G0304X | Physical Therapist - Geriatrics | 6400 | NC |
N | 2251X0800X | Physical Therapist - Orthopedic | 6400 | NC |
NPI | 1164416004 |
---|---|
Provider Name | Ms. Kristen M. Harris |
First Address | St Petersburg, FL 33747-1078 |
Second Address | Gulfport, FL 33707-5622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 07/02/2016 |