Provider Demographics
NPI:1508189853
Name:LARSON REHABILITATION SERVICES, PLC
Entity Type:Organization
Organization Name:LARSON REHABILITATION SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZANE LARSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ECS, OCS
Authorized Official - Phone:928-526-3031
Mailing Address - Street 1:1600 W UNIVERSITY AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3114
Mailing Address - Country:US
Mailing Address - Phone:928-526-3031
Mailing Address - Fax:928-526-3098
Practice Address - Street 1:1600 W UNIVERSITY AVE
Practice Address - Street 2:STE 106
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3114
Practice Address - Country:US
Practice Address - Phone:928-526-3031
Practice Address - Fax:928-526-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
204R00000X
AZ57582251E1300X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Multi-Specialty