MEDICARE: DONNA MARIE HARRISON PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA00480	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTA00804	OTHER	OH	OTPTAT BOARD

General Provider Information

NPI Number	:	1922313915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA MARIE HARRISON PTA

Provider Business Mailing Address
First Line	:	20611 EUCLID AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44117-1521
Country	:	US
Telephone Number	:	216-481-4010
Fax Number	:	216-481-4101

Provider Business Practice Location Address
First Line	:	20611 EUCLID AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44117-1521
Country	:	US
Telephone Number	:	216-481-4010
Fax Number	:	216-481-4101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2010

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