Provider Demographics
NPI:1487686010
Name:HARRISON, MICHELE R (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:R
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 APPLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-2101
Mailing Address - Country:US
Mailing Address - Phone:703-622-5319
Mailing Address - Fax:
Practice Address - Street 1:118 APPLEGATE DR
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-2101
Practice Address - Country:US
Practice Address - Phone:703-622-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050057142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00B802A92Medicare ID - Type Unspecified
VAP88985Medicare UPIN