Provider Demographics
NPI:1841669835
Name:HARRISON, PATRICK DILLON (LMP)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:DILLON
Last Name:HARRISON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 103RD AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4983
Mailing Address - Country:US
Mailing Address - Phone:425-451-1232
Mailing Address - Fax:
Practice Address - Street 1:37 103RD AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5689
Practice Address - Country:US
Practice Address - Phone:425-451-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60601189225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist