Provider Demographics
NPI:1144272014
Name:HARRIS, DAVID (DPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25117 SW PARKWAY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:971-255-4079
Mailing Address - Fax:
Practice Address - Street 1:3060 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3053
Practice Address - Country:US
Practice Address - Phone:503-535-4700
Practice Address - Fax:503-797-6702
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005758Medicaid
OR135642Medicare PIN