Provider Demographics
NPI:1336104850
Name:HARRIS, KRISTI L (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:L
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 1:567 HWY 67 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455
Mailing Address - Country:US
Mailing Address - Phone:870-248-1119
Mailing Address - Fax:870-277-0896
Practice Address - Street 1:567 HWY 67 S
Practice Address - Street 2:SUITE B
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455
Practice Address - Country:US
Practice Address - Phone:870-248-1119
Practice Address - Fax:870-277-0896
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140874721Medicaid
AR5W384OtherBLUE CROSS BLUE SHIELD