Provider Demographics
NPI:1215621677
Name:HARPER, GEORGE DANA JR (LMT/CRT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:DANA
Last Name:HARPER
Suffix:JR
Gender:M
Credentials:LMT/CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54A MAIN RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04578-3126
Mailing Address - Country:US
Mailing Address - Phone:207-651-3211
Mailing Address - Fax:
Practice Address - Street 1:54A MAIN RD
Practice Address - Street 2:
Practice Address - City:WESTPORT ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04578-3126
Practice Address - Country:US
Practice Address - Phone:207-651-3211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT7197225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist