Provider Demographics
NPI:1255661419
Name:HARRIS, IAN (MT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352076
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80035-2076
Mailing Address - Country:US
Mailing Address - Phone:303-920-2350
Mailing Address - Fax:888-455-8560
Practice Address - Street 1:2008 W 120TH AVE STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2446
Practice Address - Country:US
Practice Address - Phone:303-920-2350
Practice Address - Fax:888-455-8560
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8243225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist