Provider Demographics
NPI:1760777049
Name:HARRISON, LEON (ATP)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 IH 35 S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-5100
Mailing Address - Country:US
Mailing Address - Phone:830-832-4669
Mailing Address - Fax:187-757-4807
Practice Address - Street 1:3702 IH 35 S
Practice Address - Street 2:SUITE 110
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5100
Practice Address - Country:US
Practice Address - Phone:830-832-4669
Practice Address - Fax:187-757-4807
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATP 6871247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other