Provider Demographics
NPI:1629428677
Name:HARRIS, GREGORY (PT)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E BULLARD AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5866
Mailing Address - Country:US
Mailing Address - Phone:559-438-8531
Mailing Address - Fax:559-438-8307
Practice Address - Street 1:1700 E BULLARD AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5866
Practice Address - Country:US
Practice Address - Phone:559-438-8531
Practice Address - Fax:559-438-8307
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist