Provider Demographics
NPI:1437450830
Name:HARRIS, SHANNON BRUCE (PT)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:BRUCE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:9665 WILSHIRE BLVD
Mailing Address - Street 2:#222
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2340
Mailing Address - Country:US
Mailing Address - Phone:310-247-8414
Mailing Address - Fax:310-247-9414
Practice Address - Street 1:9665 WILSHIRE BLVD
Practice Address - Street 2:#222
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2340
Practice Address - Country:US
Practice Address - Phone:310-247-8414
Practice Address - Fax:310-247-9414
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 242062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic