Provider Demographics
NPI:1912020900
Name:LARSON, DAVID N (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:N
Last Name:LARSON
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 1:7166 GATESHEAD WAY
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1340
Mailing Address - Country:US
Mailing Address - Phone:818-212-8100
Mailing Address - Fax:818-887-0213
Practice Address - Street 1:13652 CANTARA ST
Practice Address - Street 2:BALBOA PLAZA
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-832-7272
Practice Address - Fax:818-832-7249
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 006643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist