Provider Demographics
NPI:1396960779
Name:FURRY, LARRY (PTA)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:
Last Name:FURRY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19531 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2902
Mailing Address - Country:US
Mailing Address - Phone:714-960-7995
Mailing Address - Fax:714-960-1884
Practice Address - Street 1:19531 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2902
Practice Address - Country:US
Practice Address - Phone:714-960-7995
Practice Address - Fax:714-960-1884
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 2369225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT2369OtherCA PT BOARD
CAAT2369OtherCA PT BOARD