Provider Demographics
NPI:1023070620
Name:HARRIS, MARGARITA (PT)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
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 1:2328 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1459
Mailing Address - Country:US
Mailing Address - Phone:239-573-1518
Mailing Address - Fax:239-573-7356
Practice Address - Street 1:4316 LEE BLVD
Practice Address - Street 2:12A & 12B
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1735
Practice Address - Country:US
Practice Address - Phone:239-368-7744
Practice Address - Fax:239-368-7824
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68-6520OtherMEDICARE GROUP