MEDICARE: ROBERT HARRIS PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	298023	CA
2	225100000X	Physical Therapist	27806	MD

General Provider Information

NPI Number	:	1386260776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT HARRIS PT, DPT

Provider Business Mailing Address
First Line	:	2011 DEWEY DR
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-2221
Country	:	US
Telephone Number	:	443-254-6528
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 BALLENGER AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-6818
Country	:	US
Telephone Number	:	443-254-6528
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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