Provider Demographics
NPI:1124142765
Name:HARRIS, HEIDI D (MPT)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:D
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3931
Mailing Address - Country:US
Mailing Address - Phone:410-384-9129
Mailing Address - Fax:410-384-9725
Practice Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3931
Practice Address - Country:US
Practice Address - Phone:410-544-2500
Practice Address - Fax:410-384-9703
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD21702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist