Provider Demographics
NPI:1689054835
Name:HARRIS, DILLON C (DPT)
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320A W UNION HILLS DR
Mailing Address - Street 2:SUITE 265
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7177
Mailing Address - Country:US
Mailing Address - Phone:623-374-2424
Mailing Address - Fax:623-374-2619
Practice Address - Street 1:6320A W UNION HILLS DR
Practice Address - Street 2:SUITE 265
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7177
Practice Address - Country:US
Practice Address - Phone:623-374-2424
Practice Address - Fax:623-374-2619
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist