Provider Demographics
| NPI: | 1215063052 |
|---|---|
| Name: | SUSAN J. HARRIS, INC |
| Entity type: | Organization |
| Organization Name: | SUSAN J. HARRIS, INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | MARY |
| Authorized Official - Middle Name: | LITTLE LOUISE |
| Authorized Official - Last Name: | HARRIS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 858-514-0375 |
| Mailing Address - Street 1: | 3760 CONVOY ST STE 204 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SAN DIEGO |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 92111-3744 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 858-514-0375 |
| Mailing Address - Fax: | 858-514-0383 |
| Practice Address - Street 1: | 251 LANDIS AVE STE 201 |
| Practice Address - Street 2: | |
| Practice Address - City: | CHULA VISTA |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 91910-2629 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 619-498-8450 |
| Practice Address - Fax: | 619-498-8453 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-02-26 |
| Last Update Date: | 2025-09-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 2251H1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | Group - Multi-Specialty |
| No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
| No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics | Group - Multi-Specialty |
| No | 225XE1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Ergonomics | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CA | 05-6630 | Medicare ID - Type Unspecified | REHABILITATION AGENCY |
