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General NPI Number Information
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NPI Number | 1790088920
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Entity Type | Individual
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Provider Name | ROBERT MICHAEL HARRISON MS,ATC,LAT,LMT,PES
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Gender | Male
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 12/21/2010
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Provider Practice Location Address
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Address Line | 2800 UNIVERSITY BLVD N
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City | JACKSONVILLE
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State | FL
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Zip | 32211-3321
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Country | US
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Telephone | 904-256-7886
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Fax |
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Provider Business Mailing Address
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Address Line | 7925 MERRILL RD APT 1108
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City | JACKSONVILLE
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State | FL
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Zip | 32277-3774
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA55420
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL2719
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License Number State | FL
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