Provider Demographics
NPI:1578756995
Name:HARRIS, TIMOTHY TERRELL SR (PTA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:TERRELL
Last Name:HARRIS
Suffix:SR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 FARRAGUT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-2818
Mailing Address - Country:US
Mailing Address - Phone:504-905-2345
Mailing Address - Fax:
Practice Address - Street 1:1488 FARRAGUT ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-2818
Practice Address - Country:US
Practice Address - Phone:504-905-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA6483225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant