Provider Demographics
NPI:1962775346
Name:HARRIS, DUSTIN LEA (PT)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:LEA
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 1:10398 ROCKINGHAM DR STE 9
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2507
Mailing Address - Country:US
Mailing Address - Phone:916-693-1837
Mailing Address - Fax:916-720-0211
Practice Address - Street 1:10398 ROCKINGHAM DR STE 9
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2507
Practice Address - Country:US
Practice Address - Phone:916-693-1837
Practice Address - Fax:916-720-0211
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2025-01-16
Deactivation Date:2025-01-02
Deactivation Code:
Reactivation Date:2025-01-16
Provider Licenses
StateLicense IDTaxonomies
CA303645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist