Active NPI
Jeremy Harris, PT, DPT, ATC
- Physical Therapist
- Goodyear, AZ
National Provider Identifier
1104288224
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12328
- Practice address
- 2601 S Wood Blvd
Goodyear, AZ 85338-6914 - Phone
- (623) 302-5678
- NPI assigned
- Mar 28, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1463 | AZ | |
| Physical Therapist | 225100000X | 12328 | AZ | Primary |
Addresses
Primary practice location
2601 S Wood Blvd
Goodyear, AZ 85338-6914
Mailing address
26300 Village LN
Suite 218
Beachwood, OH 44122-7565
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12328 | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467158400000",
"number": "1104288224",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26300 VILLAGE LN",
"address_2": "SUITE 218",
"city": "BEACHWOOD",
"state": "OH",
"postal_code": "441227565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 S WOOD BLVD",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853386914",
"telephone_number": "623-302-5678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "JEREMY",
"name_prefix": "Dr.",
"credential": "PT, DPT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-28",
"last_updated": "2016-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AZ",
"license": "1463",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "12328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.