Provider Demographics
NPI:1184672297
Name:HARMON, MICHAEL JACK (MPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JACK
Last Name:HARMON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:JACK
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:304 LANIER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-6357
Mailing Address - Country:US
Mailing Address - Phone:336-629-0086
Mailing Address - Fax:336-629-0098
Practice Address - Street 1:304 LANIER AVE
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5527
Practice Address - Country:US
Practice Address - Phone:336-629-0086
Practice Address - Fax:336-629-0098
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079VYOtherBCBS
NC562105904OtherCIGNA
NCP00289576Medicaid
NC11531693OtherCAQH
NC694617OtherUNITED HEALTH CARE
NC806917OtherPARTNERS
NC9409737OtherPHCS
NC562105904OtherTRICARE
NC7880751OtherAETNA
NC2507972Medicare ID - Type Unspecified