Provider Demographics
NPI:1548350234
Name:HARRIS, KRISTIN DAVIS (MPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:DAVIS
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1030 SIENA DR STE 120
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2781
Mailing Address - Country:US
Mailing Address - Phone:919-232-5020
Mailing Address - Fax:919-341-3323
Practice Address - Street 1:1030 SIENA DR STE 120
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2781
Practice Address - Country:US
Practice Address - Phone:919-232-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP108202251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212159Medicaid
NC0676KOtherBLUE CROSS BLUE SHIELD