Provider Demographics
NPI:1093955452
Name:BAGENT, LARRY DOUGLAS (LMT)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DOUGLAS
Last Name:BAGENT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5136 BONNER DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8933
Mailing Address - Country:US
Mailing Address - Phone:614-313-3437
Mailing Address - Fax:
Practice Address - Street 1:5136 BONNER DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-8933
Practice Address - Country:US
Practice Address - Phone:614-313-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16050172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist