Provider Demographics
NPI:1437350758
Name:HARRIS, MARK MATTHEW (LMP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MATTHEW
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 WOODLAWN AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5433
Mailing Address - Country:US
Mailing Address - Phone:206-517-5433
Mailing Address - Fax:206-517-5533
Practice Address - Street 1:7010 WOODLAWN AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5433
Practice Address - Country:US
Practice Address - Phone:206-517-5433
Practice Address - Fax:206-517-5533
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022012225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist