Provider Demographics
NPI:1801443734
Name:HARRIS, EZEKIEL LEE
Entity type:Individual
Prefix:DR
First Name:EZEKIEL
Middle Name:LEE
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 1:3731 PARKLINE DR APT 308
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4051
Mailing Address - Country:US
Mailing Address - Phone:870-404-3942
Mailing Address - Fax:
Practice Address - Street 1:8510 WILKINSVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1537
Practice Address - Country:US
Practice Address - Phone:901-873-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist