MEDICARE: BERNETTE HARRISON LMT

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	225700000X	Massage Therapist	18KT00552900	NJ

General Provider Information

NPI Number	:	1053743500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNETTE HARRISON LMT

Provider Business Mailing Address
First Line	:	507 U.S., 9 SOUTH
Second Line	:
City	:	MARMORA
State	:	NJ
Zip	:	08223
Country	:	US
Telephone Number	:	609-334-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	536 WASHINGTON AVE
Second Line	:
City	:	WOODBINE
State	:	NJ
Zip	:	08270-2025
Country	:	US
Telephone Number	:	609-334-2511
Fax Number	:

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

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	11/27/2023

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