Provider Demographics
NPI:1124400098
Name:HARRIS, KATHRYN (DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 441146
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30160
Mailing Address - Country:US
Mailing Address - Phone:678-403-3568
Mailing Address - Fax:678-567-6737
Practice Address - Street 1:8199 NAVARRE PKWY
Practice Address - Street 2:UNIT 12A
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-6941
Practice Address - Country:US
Practice Address - Phone:850-939-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0S8NOtherFLORIDA BLUE
FLY0S8NOtherFLORIDA BLUE