Provider Demographics
NPI:1053710434
Name:HARRISON, CHARIS L (DPT)
Entity type:Individual
Prefix:
First Name:CHARIS
Middle Name:L
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MONTANA ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3348
Mailing Address - Country:US
Mailing Address - Phone:406-596-2793
Mailing Address - Fax:406-660-4145
Practice Address - Street 1:610 N MONTANA ST STE 3
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3348
Practice Address - Country:US
Practice Address - Phone:406-596-2793
Practice Address - Fax:406-660-4145
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7579225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist