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General NPI Number Information
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NPI Number | 1265518344
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Entity Type | Individual
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Provider Name | MICAH BRADLEY HARRISS P.T.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3527 AMBASSADOR CAFFERY PKWY BOX 13
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City | LAFAYETTE
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State | LA
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Zip | 70503-5130
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Country | US
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Telephone | 337-857-6178
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Fax | 337-857-6592
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Provider Business Mailing Address
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Address Line | 512 SABBATH RD
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City | YOUNGSVILLE
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State | LA
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Zip | 70592-5953
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Country | US
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Telephone | 337-856-9625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 004463
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License Number State | LA
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