Provider Demographics
NPI:1013187897
Name:HARRIS, NATALIE KOONTZ (DPT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:KOONTZ
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5790 COODY DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092-6104
Mailing Address - Country:US
Mailing Address - Phone:229-273-3053
Mailing Address - Fax:
Practice Address - Street 1:902 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3344
Practice Address - Country:US
Practice Address - Phone:478-987-1610
Practice Address - Fax:478-987-1640
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA598119283CMedicaid