Provider Demographics
NPI:1700979606
Name:LARSON, LORILEE C (PT)
Entity Type:Individual
Prefix:
First Name:LORILEE
Middle Name:C
Last Name:LARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27805 481ST AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-5543
Mailing Address - Country:US
Mailing Address - Phone:320-979-0232
Mailing Address - Fax:605-356-8075
Practice Address - Street 1:8011 S CINNAMON RIDGE PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-6466
Practice Address - Country:US
Practice Address - Phone:605-951-0417
Practice Address - Fax:605-356-8075
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11512251P0200X, 225100000X
MN7066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650001540Medicare PIN