Provider Demographics
NPI:1144391368
Name:MESSENGER, LARRY (PT)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MESSENGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W K ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2938
Mailing Address - Country:US
Mailing Address - Phone:360-462-0262
Mailing Address - Fax:360-462-0263
Practice Address - Street 1:121 W K ST
Practice Address - Street 2:SUITE C
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2938
Practice Address - Country:US
Practice Address - Phone:360-462-0262
Practice Address - Fax:360-462-0263
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT7839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist