Provider Demographics
NPI:1205719838
Name:HARRIS, ROBERT THOMAS (AT STUDENT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:HARRIS
Suffix:
Gender:M
Credentials:AT STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 HIGHWAY 362
Mailing Address - Street 2:
Mailing Address - City:NABB
Mailing Address - State:IN
Mailing Address - Zip Code:47147-9749
Mailing Address - Country:US
Mailing Address - Phone:502-689-1504
Mailing Address - Fax:
Practice Address - Street 1:2087 ACORN BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-7306
Practice Address - Country:US
Practice Address - Phone:317-738-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer