Provider Demographics
NPI:1558593541
Name:POPER, LARRY A II (PTA)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:A
Last Name:POPER
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 MAR JOY RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5292
Mailing Address - Country:US
Mailing Address - Phone:910-323-3223
Mailing Address - Fax:910-433-5608
Practice Address - Street 1:3532 DUNN RD
Practice Address - Street 2:
Practice Address - City:EASTOVER
Practice Address - State:NC
Practice Address - Zip Code:28312-8894
Practice Address - Country:US
Practice Address - Phone:910-323-3223
Practice Address - Fax:910-433-5608
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1916225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant