Provider Demographics
NPI:1376842443
Name:HARRIS, VANESSA (CMT)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24436 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3851
Mailing Address - Country:US
Mailing Address - Phone:928-581-2844
Mailing Address - Fax:
Practice Address - Street 1:29990 HUNTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2768
Practice Address - Country:US
Practice Address - Phone:951-461-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10673225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist