Provider Demographics
NPI:1366566507
Name:HARRIS, DOUGLAS K (MS, PT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:K
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 PITCHER CANYON ROAD
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801
Mailing Address - Country:US
Mailing Address - Phone:509-663-6254
Mailing Address - Fax:
Practice Address - Street 1:803 HACIENDA LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-5109
Practice Address - Country:US
Practice Address - Phone:505-632-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003821225100000X
NMPT-2024-0319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7052665Medicaid
WAR12281Medicare UPIN
WAGAB00884Medicare ID - Type Unspecified