Provider Demographics
NPI:1225002181
Name:FRESHOUR, LARRY R (PT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:R
Last Name:FRESHOUR
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 1:105 W 8TH
Mailing Address - Street 2:# 170
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2312
Mailing Address - Country:US
Mailing Address - Phone:509-838-4700
Mailing Address - Fax:509-838-4716
Practice Address - Street 1:3010 SE BLVD
Practice Address - Street 2:# F
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223
Practice Address - Country:US
Practice Address - Phone:509-533-9003
Practice Address - Fax:509-533-9010
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 00007067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA158987OtherLTI
WA8335135Medicaid
WAAB27493Medicare ID - Type Unspecified