MEDICARE: GAYLA HARRIS PT

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	1007474	TX
2	225700000X	Massage Therapist	MT013300	TX

General Provider Information

NPI Number	:	1912932070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLA HARRIS PT

Provider Business Mailing Address
First Line	:	2162 SOUTH LAMAR BLVD
Second Line	:	STE A
City	:	AUSTIN
State	:	TX
Zip	:	78704-4733
Country	:	US
Telephone Number	:	512-804-1100
Fax Number	:	512-804-1102

Provider Business Practice Location Address
First Line	:	2612 S LAMAR BLVD
Second Line	:	SUITE A
City	:	AUSTIN
State	:	TX
Zip	:	78704-4733
Country	:	US
Telephone Number	:	512-804-1100
Fax Number	:	512-804-1102

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	06/08/2011

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Directions to “ GAYLA HARRIS PT” Practice Location

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