Provider Demographics
NPI:1255694501
Name:HARRIS PHYSICAL THERAPY - SPORT & SPINE SPECIALISTS, INC
Entity Type:Organization
Organization Name:HARRIS PHYSICAL THERAPY - SPORT & SPINE SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:541-980-5729
Mailing Address - Street 1:623 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2415
Mailing Address - Country:US
Mailing Address - Phone:541-980-5729
Mailing Address - Fax:541-550-2228
Practice Address - Street 1:623 E 2ND ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2415
Practice Address - Country:US
Practice Address - Phone:541-980-5729
Practice Address - Fax:541-550-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy