Provider Demographics
NPI:1609219732
Name:HARRISON, ASIYIH LUA CARMEL (LMT)
Entity Type:Individual
Prefix:MISS
First Name:ASIYIH
Middle Name:LUA CARMEL
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 NW SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3711
Mailing Address - Country:US
Mailing Address - Phone:503-504-0497
Mailing Address - Fax:
Practice Address - Street 1:3590 NW SOUTH RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5105
Practice Address - Country:US
Practice Address - Phone:503-504-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19735172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist