Individual
LISA E HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
233 N COURT ST, FAYETTEVILLE, WV 25840-1233
(304) 574-1416
(304) 574-1474
Mailing address
233 N COURT ST, FAYETTEVILLE, WV 25840-1233
(304) 574-1416
(304) 574-1474
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
902
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0156959000
—
WV
01
—
1003994054
RR MEDICARE, GROUP NPI/PTAN #650011748
WV
Enumeration date
01/08/2008
Last updated
04/28/2014
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