Provider Demographics
NPI:1184664096
Name:HARRIS, JOSEPH MICHAEL JR (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 26
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42755
Mailing Address - Country:US
Mailing Address - Phone:270-230-1729
Mailing Address - Fax:270-230-1750
Practice Address - Street 1:201 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754
Practice Address - Country:US
Practice Address - Phone:270-230-1729
Practice Address - Fax:270-230-1750
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000179577OtherANTHEM BC/BS
KY8700022000Medicaid
KYP18678Medicare UPIN
KY000000179577OtherANTHEM BC/BS