Provider Demographics
NPI:1225195621
Name:HARRIS, WENDY (MS, PT)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3000 JOHNSON RD SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-5847
Mailing Address - Country:US
Mailing Address - Phone:256-650-1723
Mailing Address - Fax:256-650-1781
Practice Address - Street 1:3000 JOHNSON RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-5847
Practice Address - Country:US
Practice Address - Phone:256-650-1723
Practice Address - Fax:256-650-1781
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH428172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker