Healthcare Provider Details

I. General information

NPI: 1932116514
Provider Name (Legal Business Name): JOHN HARRISON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9261 FOLSOM BLVD 200
SACRAMENTO CA
95826-2561
US

IV. Provider business mailing address

9992 WINGED FOOT DR
SACRAMENTO CA
95829-8000
US

V. Phone/Fax

Practice location:
  • Phone: 916-364-1733
  • Fax: 916-364-5255
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 25905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: