Provider Demographics
NPI:1710596200
Name:HARRIS, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 N IH 35 STE 1330
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-1028
Mailing Address - Country:US
Mailing Address - Phone:512-254-2346
Mailing Address - Fax:512-254-2347
Practice Address - Street 1:12901 N IH 35 STE 1330
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1028
Practice Address - Country:US
Practice Address - Phone:512-254-2346
Practice Address - Fax:512-254-2347
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3125674225100000X
TX1335911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist