Provider Demographics
NPI:1215183876
Name:HARRISON, MARK ERIC (DPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ERIC
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 S WILLIAMS PL
Mailing Address - Street 2:STE 110
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1867
Mailing Address - Country:US
Mailing Address - Phone:509-737-0333
Mailing Address - Fax:509-737-0355
Practice Address - Street 1:2620 S WILLIAMS PL
Practice Address - Street 2:STE 110
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-1867
Practice Address - Country:US
Practice Address - Phone:509-737-0333
Practice Address - Fax:509-737-0355
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60014261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist