Provider Demographics
NPI:1053155879
Name:HARRISON, AMY A (AT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:HARRISON
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:A
Other - Last Name:ROUTTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT
Mailing Address - Street 1:5183 HANOVER CLOSE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8728
Mailing Address - Country:US
Mailing Address - Phone:740-973-1129
Mailing Address - Fax:
Practice Address - Street 1:5150 E DUBLIN GRANVILLE RD STE 130
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-7023
Practice Address - Country:US
Practice Address - Phone:614-566-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-21822083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine