Provider Demographics
NPI:1134209026
Name:NAVA, LARRY LUJAN (DPT)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LUJAN
Last Name:NAVA
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 1:805 W ACEQUIA AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6162
Mailing Address - Country:US
Mailing Address - Phone:559-625-3838
Mailing Address - Fax:559-625-1309
Practice Address - Street 1:805 W ACEQUIA AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6162
Practice Address - Country:US
Practice Address - Phone:559-625-3838
Practice Address - Fax:559-625-1309
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT77260Medicare ID - Type Unspecified