Provider Demographics
NPI:1457499584
Name:HARRISON, ROBERT BURNHAM JR (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BURNHAM
Last Name:HARRISON
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4120 WEST POINT LOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110
Mailing Address - Country:US
Mailing Address - Phone:619-226-4131
Mailing Address - Fax:619-226-4124
Practice Address - Street 1:5962 LA PLACE CT
Practice Address - Street 2:SUITE 170
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-8807
Practice Address - Country:US
Practice Address - Phone:800-929-4776
Practice Address - Fax:760-831-8370
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 33077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist