Provider Demographics
NPI:1154770568
Name:HARRIS, DANIEL JORDAN (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JORDAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 BRIERLY LN
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-1210
Mailing Address - Country:US
Mailing Address - Phone:609-792-6965
Mailing Address - Fax:
Practice Address - Street 1:442 BRIERLY LN
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-1210
Practice Address - Country:US
Practice Address - Phone:609-792-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025192261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy