Provider Demographics
NPI:1649352584
Name:HARLAN, PATTI KELLETT (PTA)
Entity type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:KELLETT
Last Name:HARLAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 NORTH LAURENS RD
Mailing Address - Street 2:
Mailing Address - City:GRAY COURT
Mailing Address - State:SC
Mailing Address - Zip Code:29645
Mailing Address - Country:US
Mailing Address - Phone:864-444-0580
Mailing Address - Fax:
Practice Address - Street 1:125 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4812
Practice Address - Country:US
Practice Address - Phone:864-675-4393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1699225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant