Provider Demographics
NPI:1033522099
Name:LARSSON, THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LARSSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 CENTENNIAL BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0589
Mailing Address - Country:US
Mailing Address - Phone:850-656-1837
Mailing Address - Fax:850-877-2917
Practice Address - Street 1:205 NE DARTMOOR DR
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9616
Practice Address - Country:US
Practice Address - Phone:515-987-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist