Provider Demographics
NPI:1962009977
Name:HARRISON REHAB & WELLNESS HEALTHCARE AGENCY, LLC
Entity Type:Organization
Organization Name:HARRISON REHAB & WELLNESS HEALTHCARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-292-3294
Mailing Address - Street 1:875 W. POPLAR AVE / SUITE 23 / #203
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017
Mailing Address - Country:US
Mailing Address - Phone:901-292-2394
Mailing Address - Fax:
Practice Address - Street 1:5558 LIBERTY RIDGE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4262
Practice Address - Country:US
Practice Address - Phone:901-292-3294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy