Provider Demographics
NPI:1922299254
Name:HARRIS, JAMISYN ANNE (PT)
Entity Type:Individual
Prefix:
First Name:JAMISYN
Middle Name:ANNE
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 1:524 BRYN MAWR DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2302
Mailing Address - Country:US
Mailing Address - Phone:505-681-9553
Mailing Address - Fax:
Practice Address - Street 1:5201 ROMA AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1334
Practice Address - Country:US
Practice Address - Phone:505-262-2311
Practice Address - Fax:505-262-2426
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist