Provider Demographics
NPI:1518298405
Name:ORR, LARRY ERLIN
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ERLIN
Last Name:ORR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LARRY
Other - Middle Name:ERLIN
Other - Last Name:ORR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPTA
Mailing Address - Street 1:111 TEELIN DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-6156
Mailing Address - Country:US
Mailing Address - Phone:248-628-3206
Mailing Address - Fax:248-628-3206
Practice Address - Street 1:111 TEELIN DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6156
Practice Address - Country:US
Practice Address - Phone:248-628-3206
Practice Address - Fax:248-628-3206
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-17
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001446225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant