Healthcare Provider Details

I. General information

NPI: 1326380106
Provider Name (Legal Business Name): MICHAEL CHARLES HARRIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9441 LBJ FWY STE 104
DALLAS TX
75243-4637
US

IV. Provider business mailing address

1007 LANSDALE DR
DUNCANVILLE TX
75116-4410
US

V. Phone/Fax

Practice location:
  • Phone: 214-575-9820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1193913
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: