Healthcare Provider Details

I. General information

NPI: 1104748664
Provider Name (Legal Business Name): JULIAN ALEXANDER GARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 E MARKET ST
WEST CHESTER PA
19382-4806
US

IV. Provider business mailing address

416 CYPRESS KNEES LN
MONCKS CORNER SC
29461-8455
US

V. Phone/Fax

Practice location:
  • Phone: 843-371-7143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberTPT024110
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: