MEDICARE: DANZELL HARRIS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT019535	OH

General Provider Information

NPI Number	:	1386308070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANZELL HARRIS DPT

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0001
Country	:	US
Telephone Number	:	216-444-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 E ROYALTON RD
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2840
Country	:	US
Telephone Number	:	866-320-4573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	08/26/2023

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