Provider Demographics
NPI:1215236294
Name:HARRIS, MICHAEL CARLOS (RRT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CARLOS
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1505 FORT CLARKE BLVD
Mailing Address - Street 2:APT. 11-108
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7182
Mailing Address - Country:US
Mailing Address - Phone:352-381-8381
Mailing Address - Fax:352-338-1910
Practice Address - Street 1:1505 FORT CLARKE BLVD
Practice Address - Street 2:APT. 11-108
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7182
Practice Address - Country:US
Practice Address - Phone:352-381-8381
Practice Address - Fax:352-338-1910
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT8770227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered