Provider Demographics
NPI:1427043116
Name:HARRIS, WESLEY ALLEN (ATC)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:ALLEN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 SOUTHMORE ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2052
Mailing Address - Country:US
Mailing Address - Phone:317-456-2001
Mailing Address - Fax:
Practice Address - Street 1:11218 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2601
Practice Address - Country:US
Practice Address - Phone:317-838-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001148A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer