Healthcare Provider Details

I. General information

NPI: 1295932010
Provider Name (Legal Business Name): GREG L HARRIS CPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N WALNUT ST
INMAN KS
67546-8016
US

IV. Provider business mailing address

7412 N MADISON
HUTCHINSON KS
67502
US

V. Phone/Fax

Practice location:
  • Phone: 620-585-6411
  • Fax:
Mailing address:
  • Phone: 620-669-9735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-01067
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: