Provider Demographics
NPI:1508058751
Name:LARRY NORTH SPORTS MEDICINE
Entity Type:Organization
Organization Name:LARRY NORTH SPORTS MEDICINE
Other - Org Name:ADVANCED SPINE & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAREDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-488-9686
Mailing Address - Street 1:PO BOX 1731
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-1731
Mailing Address - Country:US
Mailing Address - Phone:972-488-9686
Mailing Address - Fax:972-241-1936
Practice Address - Street 1:4801 SPRING VALLEY RD
Practice Address - Street 2:SUITE 40
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244
Practice Address - Country:US
Practice Address - Phone:972-488-9686
Practice Address - Fax:972-241-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6832111NS0005X
TX10069111NS0005X
TX9801111NS0005X
TXPT1126068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty