Provider Demographics
NPI:1659764074
Name:LARSEN, DAVID (M A, AT, C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:LARSEN
Suffix:
Gender:M
Credentials:M A, AT, C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21726 PLACERITA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-1235
Mailing Address - Country:US
Mailing Address - Phone:661-362-2764
Mailing Address - Fax:
Practice Address - Street 1:21726 PLACERITA CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-1235
Practice Address - Country:US
Practice Address - Phone:661-362-2764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1291023982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer