Provider Demographics
NPI:1881712339
Name:STARR, LARRY M (EDD, ATC, LAT, CSCS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:M
Last Name:STARR
Suffix:
Gender:M
Credentials:EDD, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 BRIDGEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-5624
Mailing Address - Country:US
Mailing Address - Phone:513-630-1518
Mailing Address - Fax:954-752-8348
Practice Address - Street 1:3516 MAHOGANY WAY
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-6047
Practice Address - Country:US
Practice Address - Phone:954-752-8178
Practice Address - Fax:954-752-8348
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 4552255A2300X
OHAT 0004942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer