Provider Demographics
NPI:1013551415
Name:HARRISON, DANIEL JOHN (ATC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:HARRISON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 CEDAR LN APT 1
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-3616
Mailing Address - Country:US
Mailing Address - Phone:201-655-9499
Mailing Address - Fax:
Practice Address - Street 1:2130 BRANNER AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2210
Practice Address - Country:US
Practice Address - Phone:865-471-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000022322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer