Provider Demographics
NPI:1700815297
Name:HARRIS, TODD (DPT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 140C
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9787
Mailing Address - Country:US
Mailing Address - Phone:570-265-7688
Mailing Address - Fax:570-265-7422
Practice Address - Street 1:2125 NOLL DR
Practice Address - Street 2:STE 100
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7606
Practice Address - Country:US
Practice Address - Phone:717-291-9920
Practice Address - Fax:717-391-9925
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104885R9XMedicare Oscar/Certification
PA104885PV9Medicare PIN