Provider Demographics
NPI:1285967000
Name:HARRISON, TAMERA CHANAE (MS,PT)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:CHANAE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5558 LIBERTY RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4262
Mailing Address - Country:US
Mailing Address - Phone:901-292-3294
Mailing Address - Fax:901-756-6838
Practice Address - Street 1:5558 LIBERTY RIDGE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4262
Practice Address - Country:US
Practice Address - Phone:901-292-3294
Practice Address - Fax:901-756-6838
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist