Provider Demographics
NPI:1801038203
Name:HARRIS, SHELLEY L (LMBT #7972)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMBT #7972
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20006 NORTHCOVE RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6499
Mailing Address - Country:US
Mailing Address - Phone:704-787-2440
Mailing Address - Fax:
Practice Address - Street 1:20006 NORTHCOVE RD
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6499
Practice Address - Country:US
Practice Address - Phone:704-787-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7972225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist