Provider Demographics
NPI:1770720419
Name:HARLEY, ANNA M (PTA)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:M
Last Name:HARLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:LOUISE
Other - Last Name:MARSHBANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1053 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-6749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2318 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4716
Practice Address - Country:US
Practice Address - Phone:803-454-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC360225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant