Provider Demographics
NPI:1376211045
Name:HARRIS, KASSIDY JACKLYN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KASSIDY
Middle Name:JACKLYN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROYAL CREST DR APT 4
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-5434
Mailing Address - Country:US
Mailing Address - Phone:860-334-8073
Mailing Address - Fax:
Practice Address - Street 1:55 HARRIS RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2145
Practice Address - Country:US
Practice Address - Phone:603-888-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist