Provider Demographics
NPI:1720033756
Name:HARRISON, LAURIE (PT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
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 1:3121 W KENNEWICK AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2921
Mailing Address - Country:US
Mailing Address - Phone:509-735-7433
Mailing Address - Fax:509-735-6577
Practice Address - Street 1:3094 MOUNT BAKER CIR
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-9064
Practice Address - Country:US
Practice Address - Phone:360-675-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB36954Medicare ID - Type UnspecifiedMEDICARE ID #