Doctor Name: | MATTHEW DAVID HARRIS |
NPI Number: | 1346504578 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | PT-2970 |
Business Practice Address: | 901 Adams St Afton, WY - 831109621 |
Business Phone Number: | 3078855800 |
Business Fax Number: | 3078855865 |
Mailing Address: | 96 Doc Perkes Lane, AFTON |
State: | WY |
Postal Code: | 831109621 |
Phone Number: | 3078857878 |
Fax Number: | |
NPI Enumeration Date: | 07/03/2012 |
NPI Last Update Date: | 04/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | PT-2970 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ID |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |