Provider Demographics
NPI:1770655672
Name:SEMERAD, LARRY STEPHEN (BA, LMT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:STEPHEN
Last Name:SEMERAD
Suffix:
Gender:M
Credentials:BA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 DALTON DR.
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-6512
Mailing Address - Country:US
Mailing Address - Phone:850-830-4608
Mailing Address - Fax:
Practice Address - Street 1:9 GULF BREEZE CT
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-3041
Practice Address - Country:US
Practice Address - Phone:850-830-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31435225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist