Provider Demographics
NPI:1447323043
Name:HARR, DUSTY GRACE (PTA)
Entity type:Individual
Prefix:MRS
First Name:DUSTY
Middle Name:GRACE
Last Name:HARR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:DUSTY
Other - Middle Name:GRACE
Other - Last Name:SHOTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:814 LINCOLN WAY EAST
Mailing Address - Street 2:
Mailing Address - City:MCCONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-1510
Mailing Address - Country:US
Mailing Address - Phone:717-372-6968
Mailing Address - Fax:
Practice Address - Street 1:8507 MAPLEVILLE RD
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1818
Practice Address - Country:US
Practice Address - Phone:301-733-2585
Practice Address - Fax:301-733-2585
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2622225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant