Provider Demographics
NPI:1841271061
Name:HARRIS, STUART ALAN (PT)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:ALAN
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 1:911 MORAGA RD
Mailing Address - Street 2:#103
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4579
Mailing Address - Country:US
Mailing Address - Phone:925-284-3840
Mailing Address - Fax:925-284-3873
Practice Address - Street 1:911 MORAGA RD
Practice Address - Street 2:#103
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4579
Practice Address - Country:US
Practice Address - Phone:925-284-3840
Practice Address - Fax:925-284-3873
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 6914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAW851ZMedicare PIN
CA00PT69140Medicare PIN