Provider Demographics
NPI:1164112298
Name:HARRISON, ANINE GAIL (LMT)
Entity Type:Individual
Prefix:
First Name:ANINE
Middle Name:GAIL
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 WELLSIAN WAY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4116
Mailing Address - Country:US
Mailing Address - Phone:509-943-4919
Mailing Address - Fax:509-578-1012
Practice Address - Street 1:325 WELLSIAN WAY
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4116
Practice Address - Country:US
Practice Address - Phone:509-943-4919
Practice Address - Fax:509-578-1012
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61437567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA61437567OtherSTATE LICENSE