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Individual

MR. LARRY NELS LARSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.T., A.T.C., S.T.S.

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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