Provider Demographics
NPI:1407615818
Name:HARRIS, PAUL BRYAN (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:BRYAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 VINE ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:OH
Mailing Address - Zip Code:45771-9097
Mailing Address - Country:US
Mailing Address - Phone:740-416-2368
Mailing Address - Fax:
Practice Address - Street 1:2520 VALLEY DR
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2092
Practice Address - Country:US
Practice Address - Phone:304-675-4340
Practice Address - Fax:304-675-7232
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist