Provider Demographics
NPI:1558768192
Name:SAMS, LARRY LON
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LON
Last Name:SAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LARRY
Other - Middle Name:LON
Other - Last Name:SAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1005 E CEDAR CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:SEVEN POINTS
Mailing Address - State:TX
Mailing Address - Zip Code:75143-8410
Mailing Address - Country:US
Mailing Address - Phone:903-275-2455
Mailing Address - Fax:214-594-8482
Practice Address - Street 1:1005 E CEDAR CREEK PKWY
Practice Address - Street 2:
Practice Address - City:SEVEN POINTS
Practice Address - State:TX
Practice Address - Zip Code:75143-8410
Practice Address - Country:US
Practice Address - Phone:903-275-2455
Practice Address - Fax:214-594-8482
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT120955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist