Provider Demographics
NPI:1164416004
Name:HARRIS, KRISTEN M (PT, GCS)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531078
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33747-1078
Mailing Address - Country:US
Mailing Address - Phone:727-350-1012
Mailing Address - Fax:727-350-1012
Practice Address - Street 1:5126 31ST AVE S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-5622
Practice Address - Country:US
Practice Address - Phone:727-350-1012
Practice Address - Fax:727-350-1012
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64002251G0304X, 2251X0800X
FL293812251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2503862AMedicare ID - Type Unspecified
FLIH130ZMedicare PIN