Provider Demographics
NPI:1568499960
Name:HARRIS, SHEILA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
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 1:7018 HAWAII KAI DR
Mailing Address - Street 2:504
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-4150
Mailing Address - Country:US
Mailing Address - Phone:808-779-8475
Mailing Address - Fax:808-394-8702
Practice Address - Street 1:130 KAILUA RD
Practice Address - Street 2:107
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3420
Practice Address - Country:US
Practice Address - Phone:808-779-8475
Practice Address - Fax:808-394-8702
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT1956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI100474Medicare ID - Type Unspecified