Provider Demographics
NPI:1437833761
Name:HARRIS, RYAN DANIEL
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DANIEL
Last Name:HARRIS
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 1:3836 CHELSEA WAY
Mailing Address - Street 2:
Mailing Address - City:CADDO MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:75135-6251
Mailing Address - Country:US
Mailing Address - Phone:972-742-2889
Mailing Address - Fax:
Practice Address - Street 1:3836 CHELSEA WAY
Practice Address - Street 2:
Practice Address - City:CADDO MILLS
Practice Address - State:TX
Practice Address - Zip Code:75135-6251
Practice Address - Country:US
Practice Address - Phone:972-742-2889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer