Provider Demographics
NPI:1417405077
Name:HARRIS, REBECCA WELCH (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:WELCH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 AUTUMN BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1584
Mailing Address - Country:US
Mailing Address - Phone:423-650-3684
Mailing Address - Fax:
Practice Address - Street 1:1827 AUTUMN BLUFF RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-1584
Practice Address - Country:US
Practice Address - Phone:423-650-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist