Provider Demographics
NPI:1639221211
Name:LARSON-HARGRAFEN, DABNEY (PT)
Entity Type:Individual
Prefix:
First Name:DABNEY
Middle Name:
Last Name:LARSON-HARGRAFEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DABNEY
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:ISU THIELEN STUDENT HEALTH CENTER 2647 UNION DR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50011-2029
Mailing Address - Country:US
Mailing Address - Phone:515-294-2626
Mailing Address - Fax:515-294-2794
Practice Address - Street 1:ISU THOMAS B. THIELEN STUDENT HEALTH CENTER
Practice Address - Street 2:2647 UNION DRIVE
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50011
Practice Address - Country:US
Practice Address - Phone:515-294-5801
Practice Address - Fax:515-294-1190
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18932Medicaid
IA30585OtherBCBS