Provider Demographics
NPI:1902650690
Name:HARRIS, JANE (LMT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 COLLEGE DR APT 1706
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-2016
Mailing Address - Country:US
Mailing Address - Phone:850-766-3813
Mailing Address - Fax:
Practice Address - Street 1:3615 S RAILROAD ST STE D
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-2940
Practice Address - Country:US
Practice Address - Phone:334-298-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5816225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist