Provider Demographics
NPI:1336718469
Name:HARRIS, TEO ROBERT
Entity Type:Individual
Prefix:
First Name:TEO
Middle Name:ROBERT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 HOLBROOK TER NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2703
Mailing Address - Country:US
Mailing Address - Phone:202-714-3624
Mailing Address - Fax:
Practice Address - Street 1:1273 HOLBROOK TER NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2703
Practice Address - Country:US
Practice Address - Phone:202-714-3624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant