Healthcare Provider Details

I. General information

NPI: 1659725729
Provider Name (Legal Business Name): GBOLAHAN HARRIS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 W 17TH ST
HOUSTON TX
77008-3439
US

IV. Provider business mailing address

1300 W 19TH ST 7774
HOUSTON TX
77008-1689
US

V. Phone/Fax

Practice location:
  • Phone: 832-964-6216
  • Fax: 832-964-6216
Mailing address:
  • Phone: 832-964-6216
  • Fax: 832-964-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number62233
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number62233
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number62233
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number62233
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number62233
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code2279P3800X
TaxonomyPalliative/Hospice Registered Respiratory Therapist
License Number62233
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number62233
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: