Provider Demographics
NPI:1912932070
Name:HARRIS, GAYLA (PT)
Entity Type:Individual
Prefix:
First Name:GAYLA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 SOUTH LAMAR BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4733
Mailing Address - Country:US
Mailing Address - Phone:512-804-1100
Mailing Address - Fax:512-804-1102
Practice Address - Street 1:2612 S LAMAR BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4733
Practice Address - Country:US
Practice Address - Phone:512-804-1100
Practice Address - Fax:512-804-1102
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007474225100000X
TXMT013300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F2772Medicare ID - Type Unspecified