Provider Demographics
NPI:1689747529
Name:CHARRIS, JOSE D (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:D
Last Name:CHARRIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:12105 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1957
Mailing Address - Country:US
Mailing Address - Phone:954-432-3212
Mailing Address - Fax:954-367-1603
Practice Address - Street 1:12105 TAFT STREET
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026
Practice Address - Country:US
Practice Address - Phone:954-432-3212
Practice Address - Fax:954-367-1603
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886508600Medicaid
FL886508600Medicaid