Provider Demographics
NPI:1760875843
Name:LARSON, BENJAMIN (DPT)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:LARSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3318
Mailing Address - Country:US
Mailing Address - Phone:559-782-1501
Mailing Address - Fax:559-782-8528
Practice Address - Street 1:4930 W KAWEAH CT
Practice Address - Street 2:203
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8324
Practice Address - Country:US
Practice Address - Phone:559-713-6806
Practice Address - Fax:559-713-6809
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist