Active NPI
Nicholas Martin Harris, PTA
- Physical Therapy Assistant
- Southaven, MS
National Provider Identifier
1306350640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA5889
- Practice address
- 7111 Southcrest Pkwy Ste 105
Southaven, MS 38671-4851 - Phone
- (901) 261-2506
- Fax
- (901) 261-2590
- NPI assigned
- Nov 22, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA5889 | MS | Primary |
Addresses
Primary practice location
7111 Southcrest Pkwy Ste 105
Southaven, MS 38671-4851
Mailing address
4869 Stone Cross Dr
Olive Branch, MS 38654-6989
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA5889 | MS | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761264000000",
"number": "1306350640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4869 STONE CROSS DR",
"city": "OLIVE BRANCH",
"state": "MS",
"postal_code": "386546989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7111 SOUTHCREST PKWY STE 105",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386714851",
"telephone_number": "901-261-2506",
"fax_number": "901-261-2590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "NICHOLAS",
"middle_name": "MARTIN",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-11-22",
"last_updated": "2025-10-24",
"certification_date": "2025-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MS",
"license": "PTA5889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.