Provider Demographics
NPI:1831207059
Name:LARSEN, NORMAN GARY (PT)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:GARY
Last Name:LARSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 SHASTA LILY DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3821
Mailing Address - Country:US
Mailing Address - Phone:916-682-8196
Mailing Address - Fax:
Practice Address - Street 1:3680 INDUSTRIAL BLVD
Practice Address - Street 2:#550H US HEALTH WORKS MED GROUP
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691
Practice Address - Country:US
Practice Address - Phone:916-373-8896
Practice Address - Fax:916-371-4452
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT1908225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic