Individual
GRAYLING ELLIS HARRISON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
611 WATERWHEEL LN, MILLERSVILLE, MD 21108-2330
(443) 469-1140
Mailing address
611 WATERWHEEL LN APT 14, MILLERSVILLE, MD 21108-2331
(443) 469-1140
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
28447
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28447
MARYLAND PT LICENSE #
MD
Enumeration date
06/15/2021
Last updated
08/01/2024
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