Provider Demographics
NPI:1477004976
Name:HARRIS, BARBARA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11723 OLD GLENN HWY
Mailing Address - Street 2:101
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7748
Mailing Address - Country:US
Mailing Address - Phone:907-696-4878
Mailing Address - Fax:907-696-4674
Practice Address - Street 1:11723 OLD GLENN HWY
Practice Address - Street 2:101
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7748
Practice Address - Country:US
Practice Address - Phone:907-696-4878
Practice Address - Fax:907-696-4674
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101502225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist