Healthcare Provider Details

I. General information

NPI: 1942801188
Provider Name (Legal Business Name): HARRIS ESAREY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MAIN ST
COUPEVILLE WA
98239-3519
US

IV. Provider business mailing address

31955 SR 20
OAK HARBOR WA
98277
US

V. Phone/Fax

Practice location:
  • Phone: 360-682-2770
  • Fax:
Mailing address:
  • Phone: 360-679-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61101120
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: