Provider Demographics
NPI:1730196148
Name:HARRIS, JOHN ALFRED (PT, ATC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALFRED
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-8907
Mailing Address - Fax:423-954-7408
Practice Address - Street 1:900 E JACKSON BLVD
Practice Address - Street 2:STE 4
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1505
Practice Address - Country:US
Practice Address - Phone:423-218-1751
Practice Address - Fax:423-218-1752
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446557Medicaid
TN3127120OtherBC/BS OF TN
TN103I651249Medicare PIN
TN446557Medicare ID - Type Unspecified
TN3127120OtherBC/BS OF TN