Individual
CARLY KAUWELA HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
12722 TONKEL RD STE 102, FORT WAYNE, IN 46845-8201
(260) 739-0300
(260) 818-2299
Mailing address
6933 STATE ROAD 8, BUTLER, IN 46721-9759
(808) 443-9078
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05014420A
IN
225100000X
Physical Therapist
4990
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300056068
—
IN
Enumeration date
05/17/2020
Last updated
10/10/2022
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