Provider Demographics
NPI:1396463345
Name:HARRISON, AUBREY (PT)
Entity type:Individual
Prefix:
First Name:AUBREY
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 1:20873 EVA ST STE C
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-1975
Mailing Address - Country:US
Mailing Address - Phone:936-597-5323
Mailing Address - Fax:
Practice Address - Street 1:20873 EVA ST STE C
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-1975
Practice Address - Country:US
Practice Address - Phone:936-597-5323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1364537OtherSTATE LICENSE