Provider Demographics
NPI:1225011687
Name:LARSON, LORA (PT)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:LARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:
Other - Last Name:MORPHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:SCOTIA
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3412
Mailing Address - Country:US
Mailing Address - Phone:518-399-6861
Mailing Address - Fax:516-399-6864
Practice Address - Street 1:42 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:SCOTIA
Practice Address - State:NY
Practice Address - Zip Code:12302-3412
Practice Address - Country:US
Practice Address - Phone:518-399-6861
Practice Address - Fax:516-399-6864
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16596225100000X
NY030353-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69304Medicare ID - Type Unspecified