Provider Demographics
NPI:1134113665
Name:HARRIS, JOHN LAZARUS JR (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LAZARUS
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11953 BLUE SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2924
Mailing Address - Country:US
Mailing Address - Phone:904-880-2954
Mailing Address - Fax:
Practice Address - Street 1:210 N RIDGECREST LN
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3862
Practice Address - Country:US
Practice Address - Phone:904-230-1232
Practice Address - Fax:904-230-1399
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19787225100000X
GAPT007271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist