Provider Demographics
NPI:1518909043
Name:LARSON MESSMER, TERRY TENNILLE (DPT)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:TENNILLE
Last Name:LARSON MESSMER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12334 JILLIAN CIR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-5001
Mailing Address - Country:US
Mailing Address - Phone:727-505-8144
Mailing Address - Fax:
Practice Address - Street 1:12334 JILLIAN CIR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-5001
Practice Address - Country:US
Practice Address - Phone:727-505-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist