Provider Demographics
NPI:1285818039
Name:HARRIMAN, WALTER BRUNMARK JR (MSPT)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:BRUNMARK
Last Name:HARRIMAN
Suffix:JR
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12460 CAMINITO MIRA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2368
Mailing Address - Country:US
Mailing Address - Phone:619-804-2826
Mailing Address - Fax:
Practice Address - Street 1:12460 CAMINITO MIRA DEL MAR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2368
Practice Address - Country:US
Practice Address - Phone:619-804-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist