Provider Demographics
NPI:1922149137
Name:HARRISON, JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9901 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 116
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3843
Practice Address - Country:US
Practice Address - Phone:562-928-0121
Practice Address - Fax:562-806-3021
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11956225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
W15093OtherMEDICARE GROUP PROVIDER #
CA33 0286692OtherEMPLOYER TAX ID # (EIN)
WPT11956AMedicare ID - Type UnspecifiedPPIN