Provider Demographics
NPI:1891023701
Name:HARRIS, JAMES DALE (MPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DALE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9137 N SWAN CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1161
Mailing Address - Country:US
Mailing Address - Phone:314-495-2230
Mailing Address - Fax:
Practice Address - Street 1:322 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1826
Practice Address - Country:US
Practice Address - Phone:636-938-4065
Practice Address - Fax:636-938-4067
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009036029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist