Provider Demographics
NPI:1629027065
Name:PLANT, LARRY R (PT)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:R
Last Name:PLANT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 TULIP LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3048
Mailing Address - Country:US
Mailing Address - Phone:406-240-2172
Mailing Address - Fax:406-728-8260
Practice Address - Street 1:1219 TULIP LANE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802
Practice Address - Country:US
Practice Address - Phone:406-728-8260
Practice Address - Fax:406-728-8260
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0346511Medicaid