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General NPI Number Information
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NPI Number | 1790772630
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Entity Type | Individual
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Provider Name | MITZI L HARRISON PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 1800 30TH ST STE 206
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City | BOULDER
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State | CO
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Zip | 80301-1026
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Country | US
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Telephone | 720-845-0001
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Fax | 720-204-1748
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Provider Business Mailing Address
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Address Line | 675 SNOWBERRY ST
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City | LONGMONT
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State | CO
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Zip | 80503-7365
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Country | US
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Telephone | 720-829-2564
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Fax | 720-204-1748
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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 | 2251H1200X
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Taxonomy Name | Hand Physical Therapist
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License Number | 13219
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13219
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License Number State | CO
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