Provider Demographics
NPI:1659854644
Name:HARRIS, DANIEL (PTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HARRIS
Suffix:
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 1:212 W BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2440
Mailing Address - Country:US
Mailing Address - Phone:509-684-5621
Mailing Address - Fax:509-684-7943
Practice Address - Street 1:212 W BIRCH AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2440
Practice Address - Country:US
Practice Address - Phone:509-684-5621
Practice Address - Fax:509-684-7943
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160559983225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2091008Medicaid