Individual
MR. LARRY NELS LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T., A.T.C., S.T.S.
Contact information
Practice address
1717 IRVING PL, SHREVEPORT, LA 71101-4605
(318) 425-5604
(318) 222-8165
Mailing address
1717 IRVING PL, SHREVEPORT, LA 71101-4605
(318) 425-5604
(318) 222-8165
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0321
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00321
F A RICHARDS INSURANCE
LA
01
—
0321
PHYSICAL THERAPY LICENSE#
LA
01
—
09098
BC/BS OF LA GROUP #
LA
05
—
1112143
—
LA
01
—
220610
METLIFE HEALTH CARE
LA
01
—
52161
BC/BS OF LA INDIVIDUAL #
LA
01
—
PT0321
CLAIMS MANAGEMENT INC.
LA
Enumeration date
09/20/2005
Last updated
07/09/2007
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