Provider Demographics
NPI:1841884814
Name:HARRIS, JOEL (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12020 ROCK BROOK RUN APT 1804
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6811
Mailing Address - Country:US
Mailing Address - Phone:802-299-6326
Mailing Address - Fax:
Practice Address - Street 1:11500 FENWAY SOUTH DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8671
Practice Address - Country:US
Practice Address - Phone:213-395-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL47672081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine