Provider Demographics
NPI:1922523364
Name:HARRIS, STEPHEN (DPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
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 1:3429 FREMONT AVE N
Mailing Address - Street 2:STE 309
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8811
Mailing Address - Country:US
Mailing Address - Phone:206-486-5179
Mailing Address - Fax:
Practice Address - Street 1:3429 FREMONT AVE N
Practice Address - Street 2:STE 309
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8811
Practice Address - Country:US
Practice Address - Phone:206-486-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22963225100000X
WAPT60938305225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110126877AMedicaid