Provider Demographics
NPI:1275708976
Name:HARRIS, LISA L (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27921-6976
Mailing Address - Country:US
Mailing Address - Phone:252-338-0137
Mailing Address - Fax:252-338-4512
Practice Address - Street 1:901 HALSTEAD BLVD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6920
Practice Address - Country:US
Practice Address - Phone:252-338-0137
Practice Address - Fax:252-338-4512
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2358225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant