Provider Demographics
NPI:1417971243
Name:HARRIS, FRANK DAVID (LMT)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:DAVID
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 CEDAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:952-545-2143
Mailing Address - Fax:
Practice Address - Street 1:15 8TH AVE N
Practice Address - Street 2:SUITE 1
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7662
Practice Address - Country:US
Practice Address - Phone:952-933-5085
Practice Address - Fax:952-931-2159
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN67131225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist