Individual
MRS. GINA MARIA HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
62 MARKET ST, LYNN, MA 01901-1005
(339) 883-1209
Mailing address
12 DEER HAVEN RD, BEVERLY, MA 01915-1486
(781) 254-4431
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
6323
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6323
MA BOARD OF LICENSURE
—
Enumeration date
02/01/2019
Last updated
02/01/2019
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