Provider Demographics
NPI:1669624573
Name:HARRIS, TOD KELLY (PT)
Entity type:Individual
Prefix:
First Name:TOD
Middle Name:KELLY
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 1:4460 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3529
Mailing Address - Country:US
Mailing Address - Phone:504-364-6600
Mailing Address - Fax:504-364-6651
Practice Address - Street 1:4460 GENERAL MEYER AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3529
Practice Address - Country:US
Practice Address - Phone:504-364-6600
Practice Address - Fax:504-364-6651
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00614225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic