MEDICARE: CRAIG HARRIS CMT

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	174400000X	Specialist

General Provider Information

NPI Number	:	1144671728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG HARRIS CMT

Provider Business Mailing Address
First Line	:	4370 TUJUNGA AVE STE 150
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2753
Country	:	US
Telephone Number	:	818-454-1136
Fax Number	:	855-862-5432

Provider Business Practice Location Address
First Line	:	4370 TUJUNGA AVE STE 150
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2753
Country	:	US
Telephone Number	:	818-454-1136
Fax Number	:	855-862-5432

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

Provider Enumeration Date	:	06/25/2016
Last Update Date	:	06/25/2016

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