Provider Demographics
NPI:1154831477
Name:HARRISON, REX B
Entity Type:Individual
Prefix:MS
First Name:REX
Middle Name:B
Last Name:HARRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 ABIGAIL DR
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1079
Mailing Address - Country:US
Mailing Address - Phone:216-952-7333
Mailing Address - Fax:440-460-0622
Practice Address - Street 1:5128 ABIGAIL DR
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-1079
Practice Address - Country:US
Practice Address - Phone:216-952-7333
Practice Address - Fax:440-460-0622
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider