Provider Demographics
NPI:1568427359
Name:LARSON, WILLIAM GLENN (LIC PHYSICAL THERAPI)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GLENN
Last Name:LARSON
Suffix:
Gender:M
Credentials:LIC PHYSICAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:284 HIDDEN VALLEY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-525-0222
Mailing Address - Fax:
Practice Address - Street 1:1510 LAKESHORE DRIVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:507-760-7440
Practice Address - Fax:501-760-7442
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20222251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics