Provider Demographics
NPI:1912000498
Name:HARRIS, PETER (PT)
Entity Type:Individual
Prefix:
First Name:PETER
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 1:800 CARTER STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-339-4793
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:130 EMPIRE DR
Practice Address - Street 2:EMPIRE DRIVE HEALTH CENTER
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-668-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011283007OtherUNIVERA #
NY0145195OtherGHI PPO #
NYP00357162OtherMEDICARE RAILROAD #
NY050422000005OtherFIDELIS CARE #
NY159884FTOtherPREFERRED CARE #
NY000611325005OtherHEALTH NOW BCBS #
NY0191145OtherIHA #
NYRA5526Medicare ID - Type Unspecified
NYP00357162OtherMEDICARE RAILROAD #