Provider Demographics
NPI:1134330301
Name:HARRIS, AUSTIN ALLAN (PTA)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ALLAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6881 LOYOLA DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4053
Mailing Address - Country:US
Mailing Address - Phone:714-766-9378
Mailing Address - Fax:
Practice Address - Street 1:1 CIVIC PLAZA DR STE 625
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-7986
Practice Address - Country:US
Practice Address - Phone:310-549-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8309225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant