Provider Demographics
NPI:1376758862
Name:HABERMAN, LARRY (LMT, BA)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:HABERMAN
Suffix:
Gender:M
Credentials:LMT, BA
Other - Prefix:
Other - First Name:MARC
Other - Middle Name:
Other - Last Name:HABERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT, BA
Mailing Address - Street 1:3150 E PRESIDIO RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1619
Mailing Address - Country:US
Mailing Address - Phone:520-881-4582
Mailing Address - Fax:
Practice Address - Street 1:3150 E PRESIDIO RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1619
Practice Address - Country:US
Practice Address - Phone:520-881-4582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-06971P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist