Provider Demographics
NPI:1689958928
Name:SUZUKI, LARRY CARLTON (PT)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:CARLTON
Last Name:SUZUKI
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 1:7016 BELLROSE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1426
Mailing Address - Country:US
Mailing Address - Phone:505-263-7862
Mailing Address - Fax:505-881-4838
Practice Address - Street 1:4520 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1217
Practice Address - Country:US
Practice Address - Phone:505-872-9882
Practice Address - Fax:505-881-4838
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist