Provider Demographics
NPI:1760759179
Name:HARRIS, JENNIFER WEBER (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WEBER
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ROUTE 66 E
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-1224
Mailing Address - Country:US
Mailing Address - Phone:860-228-0194
Mailing Address - Fax:
Practice Address - Street 1:106 ROUTE 66 E
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237-1224
Practice Address - Country:US
Practice Address - Phone:860-228-0194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009342208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation