Provider Demographics
NPI:1154945764
Name:HARRIS, PAIGE (DPT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CANYON LOOKOUT LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2063
Mailing Address - Country:US
Mailing Address - Phone:512-818-9274
Mailing Address - Fax:
Practice Address - Street 1:9001 BRODIE LN STE C8
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5005
Practice Address - Country:US
Practice Address - Phone:512-712-4192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3125349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty