Provider Demographics
NPI:1124198627
Name:HARVEY, DOUGLAS ANDREW (PT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ANDREW
Last Name:HARVEY
Suffix:
Gender:M
Credentials:PT, CSCS
Other - Prefix:
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Mailing Address - Street 1:1199 S BELT LINE RD
Mailing Address - Street 2:# 140
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4666
Mailing Address - Country:US
Mailing Address - Phone:972-745-9060
Mailing Address - Fax:972-745-9069
Practice Address - Street 1:1199 S BELT LINE RD
Practice Address - Street 2:#140
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4666
Practice Address - Country:US
Practice Address - Phone:972-745-9060
Practice Address - Fax:972-745-9069
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1161126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J5800OtherINDIVIDUAL MEDICARE ID
TX8T6273OtherBCBS ID
TXPENDINGMedicare UPIN
TX8J5800OtherINDIVIDUAL MEDICARE ID