Individual
MR. LARRY ALLEN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
401 SW BEL AIR DR, CLATSKANIE, OR 97016
(503) 728-0424
Mailing address
PO BOX 927, CLATSKANIE, OR 97016-0927
(503) 728-0424
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0713
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269746
—
OR
01
—
L3054-03
PACIFIC SOURCE
OR
Enumeration date
11/23/2005
Last updated
07/08/2007
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