Provider Demographics
NPI:1861131864
Name:HARRIS, JEFFREY C
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 S TRI TERRA WAY
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4160
Mailing Address - Country:US
Mailing Address - Phone:385-225-4715
Mailing Address - Fax:
Practice Address - Street 1:427 S TRI TERRA WAY
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4160
Practice Address - Country:US
Practice Address - Phone:385-225-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist