Provider Demographics
NPI:1609925155
Name:HARRIMAN, LANCE
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:HARRIMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1749
Mailing Address - Country:US
Mailing Address - Phone:415-701-1000
Mailing Address - Fax:415-701-1009
Practice Address - Street 1:550 15TH ST
Practice Address - Street 2:SUITE 36A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-5029
Practice Address - Country:US
Practice Address - Phone:415-701-1000
Practice Address - Fax:415-701-1009
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist