Organization
LARSEN DUNNICLIFF PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD K LARSEN P.T. (OWNER)
(209) 473-1138
Entity
Organization
Contact information
Practice address
2087 GRAND CANAL BLVD, SUITE 17, STOCKTON, CA 95207-6651
(209) 473-1138
(209) 473-1891
Mailing address
2087 GRAND CANAL BLVD, SUITE 17, STOCKTON, CA 95207-6651
(209) 473-1138
(209) 473-1891
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
PT66770
CA
174400000X
Specialist
Primary
PT86420
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650008773
RAILROAD MEDICARE
CA
01
—
650011088
RAILROAD MEDICARE
CA
Enumeration date
02/23/2007
Last updated
11/17/2008
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