Provider Demographics
NPI:1457730590
Name:HARRISON, ANTHONY O'NEAL (LMT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:O'NEAL
Last Name:HARRISON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 LONGFELLOW AVE
Mailing Address - Street 2:3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-6100
Mailing Address - Country:US
Mailing Address - Phone:347-542-2051
Mailing Address - Fax:
Practice Address - Street 1:40 EXCHANGE PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2701
Practice Address - Country:US
Practice Address - Phone:212-685-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27025583172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist