Provider Demographics
NPI:1043431570
Name:HARRIS, RITA S (PTA)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WISCONSIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403
Mailing Address - Country:US
Mailing Address - Phone:262-687-2640
Mailing Address - Fax:262-634-3358
Practice Address - Street 1:LAKESHORE MANOR 1320 WISCONSIN AVENUE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403
Practice Address - Country:US
Practice Address - Phone:262-687-2640
Practice Address - Fax:262-634-3358
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI424-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant