Provider Demographics
NPI:1639403025
Name:MOHR, LARRY DANIEL (RMT)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:DANIEL
Last Name:MOHR
Suffix:
Gender:M
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 S WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-1513
Mailing Address - Country:US
Mailing Address - Phone:303-935-3600
Mailing Address - Fax:
Practice Address - Street 1:65 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1513
Practice Address - Country:US
Practice Address - Phone:303-934-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist