Provider Demographics
NPI:1942243936
Name:HARRIS, KIMBERLY NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:NICOLE
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:160 NETHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-1467
Mailing Address - Country:US
Mailing Address - Phone:610-466-9071
Mailing Address - Fax:
Practice Address - Street 1:337 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-2107
Practice Address - Country:US
Practice Address - Phone:717-656-0444
Practice Address - Fax:717-656-4080
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015182225100000X
PART002038A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer