Provider Demographics
NPI:1184981508
Name:HARRIS, KEVIN LEE (RRT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1932
Mailing Address - Country:US
Mailing Address - Phone:386-937-7395
Mailing Address - Fax:
Practice Address - Street 1:2936 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-1932
Practice Address - Country:US
Practice Address - Phone:386-937-7395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT 11571227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered