Provider Demographics
NPI:1376660324
Name:HARRIS, PEGGY NELL (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:NELL
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 PADGETT RD
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-2578
Mailing Address - Country:US
Mailing Address - Phone:205-919-6790
Mailing Address - Fax:
Practice Address - Street 1:9040 PADGETT RD
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-2578
Practice Address - Country:US
Practice Address - Phone:205-919-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer