Provider Demographics
NPI:1841477122
Name:ANDERSON, LARRY (PT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:ANDERSON
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 1:4211 JOE RAMSEY BLVD E
Mailing Address - Street 2:STE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7852
Mailing Address - Country:US
Mailing Address - Phone:903-408-7710
Mailing Address - Fax:903-408-7810
Practice Address - Street 1:4211 JOE RAMSEY BLVD E
Practice Address - Street 2:STE 100
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7852
Practice Address - Country:US
Practice Address - Phone:903-408-7710
Practice Address - Fax:903-408-7810
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1107258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist