Provider Demographics
NPI:1538376629
Name:HARRIS, CATHY ELIZABETH (AP LMT)
Entity type:Individual
Prefix:DR
First Name:CATHY
Middle Name:ELIZABETH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:AP LMT
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:ELIZABETH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 NORTH CAUSEWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169
Mailing Address - Country:US
Mailing Address - Phone:386-478-1333
Mailing Address - Fax:386-428-7742
Practice Address - Street 1:221 NORTH CAUSEWAY
Practice Address - Street 2:SUITE C
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169
Practice Address - Country:US
Practice Address - Phone:386-478-1333
Practice Address - Fax:386-428-7742
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1587171100000X
FLMA11064225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC5851OtherBCBS