Provider Demographics
NPI:1245531664
Name:HARRIS, PEGGIE MEREDITH (PT)
Entity type:Individual
Prefix:MRS
First Name:PEGGIE
Middle Name:MEREDITH
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 1:5050 LAKE SHORE DR.
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:OR
Mailing Address - Zip Code:97538
Mailing Address - Country:US
Mailing Address - Phone:541-218-0485
Mailing Address - Fax:541-597-2273
Practice Address - Street 1:18255 REDWOOD HWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:OR
Practice Address - Zip Code:97538
Practice Address - Country:US
Practice Address - Phone:541-218-0485
Practice Address - Fax:541-597-2273
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist