Provider Demographics
NPI:1689700072
Name:HARRISON, JENNIFER M (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
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 1:364 6TH ST
Mailing Address - Street 2:APT F
Mailing Address - City:FT RICHARDSON
Mailing Address - State:AK
Mailing Address - Zip Code:99505-1207
Mailing Address - Country:US
Mailing Address - Phone:907-301-1107
Mailing Address - Fax:
Practice Address - Street 1:6613 BRAYTON DR.
Practice Address - Street 2:STE. A
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507
Practice Address - Country:US
Practice Address - Phone:907-301-1107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPT 1792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT 1792Medicaid