Basic Information
| Provider Information | |||||||||
| NPI: | 1003920893 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | TRISHA | ||||||||
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| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 LAKESHORE DR | ||||||||
| Address2: | APT. B3 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060321263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032173182 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 TOMPKINS ST | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067081417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034190381 | ||||||||
| FaxNumber: | 2034190389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 007677 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.