Healthcare Provider Details

I. General information

NPI: 1184589897
Provider Name (Legal Business Name): CALVIN HARRISON CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 S BROADWAY
SANTA ANA CA
92701-5640
US

IV. Provider business mailing address

522 S BROADWAY
SANTA ANA CA
92701-5640
US

V. Phone/Fax

Practice location:
  • Phone: 747-365-9931
  • Fax:
Mailing address:
  • Phone: 747-365-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number57218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: