Provider Demographics
NPI:1811062847
Name:LARSON, ZANE (PT, DPT, ECS, OCS)
Entity type:Individual
Prefix:DR
First Name:ZANE
Middle Name:
Last Name:LARSON
Suffix:
Gender:M
Credentials:PT, DPT, ECS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W UNIVERSITY AVE
Mailing Address - Street 2:#106
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3114
Mailing Address - Country:US
Mailing Address - Phone:928-526-3031
Mailing Address - Fax:
Practice Address - Street 1:1600 W UNIVERSITY AVE
Practice Address - Street 2:#106
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3114
Practice Address - Country:US
Practice Address - Phone:928-526-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57582251E1300X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
71108Medicare ID - Type Unspecified