Provider Demographics
NPI:1699052050
Name:HARRIS, CHARLES WOOD (PT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:WOOD
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 CANYON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89460-6426
Mailing Address - Country:US
Mailing Address - Phone:775-265-4818
Mailing Address - Fax:775-265-4818
Practice Address - Street 1:880 CANYON CREEK LN
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89460-6426
Practice Address - Country:US
Practice Address - Phone:775-265-4818
Practice Address - Fax:775-265-4818
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-12
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist