Individual
JASON W HARLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
10876 ISABELLE DR, NEW HAVEN, IN 46774-2097
(260) 748-2233
(260) 748-2277
Mailing address
4251 LAHMEYER RD, FORT WAYNE, IN 46815-5676
(260) 432-4700
(260) 459-9262
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010353A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100257920
GROUP MEDICAID
IN
01
—
156546
GROUP MEDICARE
IN
05
—
201004810A
—
IN
Enumeration date
06/08/2010
Last updated
05/16/2011
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