Provider Demographics
NPI:1346559390
Name:HARRIS, SARAH JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:HARRIS
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:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42755-0026
Mailing Address - Country:US
Mailing Address - Phone:270-230-1729
Mailing Address - Fax:270-230-1750
Practice Address - Street 1:115 SEQUOIA DR
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1564
Practice Address - Country:US
Practice Address - Phone:270-230-1729
Practice Address - Fax:270-230-1750
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02666225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant