Organization
BASE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS M LARSON MPT (PRESIDENT)
(850) 508-7831
Entity
Organization
Contact information
Practice address
1989 CAPITAL CIR NE, SUITE 9, TALLAHASSEE, FL 32308-4493
(850) 727-5406
(850) 727-5764
Mailing address
PO BOX 14344, TALLAHASSEE, FL 32317-4344
(850) 727-5406
(850) 727-5764
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008869300
—
FL
01
—
Y90SZ
BCBSFL
FL
Enumeration date
01/22/2013
Last updated
04/17/2014
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