Provider Demographics
NPI:1437455664
Name:HARRIS, TERESA J (LMP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 22ND ST NE
Mailing Address - Street 2:#401
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-3434
Mailing Address - Country:US
Mailing Address - Phone:253-709-3658
Mailing Address - Fax:
Practice Address - Street 1:1402 22ND ST NE
Practice Address - Street 2:#401
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-3434
Practice Address - Country:US
Practice Address - Phone:253-709-3658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60190403172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist