Provider Demographics
NPI:1881097491
Name:HARRISON, JOHNNIE (DPT)
Entity type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 PAINTBRUSH DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-6209
Mailing Address - Country:US
Mailing Address - Phone:661-350-0590
Mailing Address - Fax:
Practice Address - Street 1:42055 50TH ST W STE 10
Practice Address - Street 2:
Practice Address - City:QUARTZ HILL
Practice Address - State:CA
Practice Address - Zip Code:93536-3520
Practice Address - Country:US
Practice Address - Phone:661-418-6880
Practice Address - Fax:661-466-5027
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-28
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist