Provider Demographics
NPI:1346461746
Name:HARPER, PATRICIA ANNE (PTA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANNE
Last Name:HARPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 W LIGHTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEAF RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:61047-9453
Mailing Address - Country:US
Mailing Address - Phone:815-519-5855
Mailing Address - Fax:
Practice Address - Street 1:811 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-1464
Practice Address - Country:US
Practice Address - Phone:815-234-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant