Basic Information
| Provider Information | |||||||||
| NPI: | 1164662433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | PHYLLIS | ||||||||
| MiddleName: | EILEEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 551 W LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | HAVERFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190411419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105254000 | ||||||||
| FaxNumber: | 6105266742 | ||||||||
| Practice Location | |||||||||
| Address1: | 551 W LANCASTER AVE | ||||||||
| Address2: | |||||||||
| City: | HAVERFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190411419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105254000 | ||||||||
| FaxNumber: | 6105266742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2009 | ||||||||
| LastUpdateDate: | 02/26/2009 | ||||||||
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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 | 15999 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.