Provider Demographics
NPI:1467471722
Name:LARSEN, DARRIN E (MPT)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:E
Last Name:LARSEN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W WARNER RD
Mailing Address - Street 2:#111
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2965
Mailing Address - Country:US
Mailing Address - Phone:480-756-8617
Mailing Address - Fax:480-820-9909
Practice Address - Street 1:430 W WARNER RD
Practice Address - Street 2:#111
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2965
Practice Address - Country:US
Practice Address - Phone:480-756-8617
Practice Address - Fax:480-820-9909
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71069Medicare ID - Type Unspecified
S91119Medicare UPIN