Provider Demographics
NPI:1336141514
Name:HARPER, DAVID TYRONE
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:TYRONE
Last Name:HARPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41818 N VENTURE DR
Mailing Address - Street 2:STE 120
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3188
Mailing Address - Country:US
Mailing Address - Phone:623-742-7338
Mailing Address - Fax:623-742-7339
Practice Address - Street 1:41818 N VENTURE DR
Practice Address - Street 2:STE 120
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3188
Practice Address - Country:US
Practice Address - Phone:623-742-7338
Practice Address - Fax:623-742-7339
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7725454OtherAETNA
AZAZ0401980OtherBLUE CROSS BLUE SHIELD
AZAZ0401980OtherBLUE CROSS BLUE SHIELD