Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A02761 | KY |
NPI | 1013573229 |
---|---|
Provider Name | Nikki Michelle Harris |
First Address | Burkesville, KY 42717-9317 |
Second Address | Burkesville, KY 42717-9317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2019 |
Last Update Date | 13/05/2019 |