Basic Information
| Provider Information | |||||||||
| NPI: | 1033522099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LARSSON | ||||||||
| FirstName: | THOMAS | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2615 CENTENNIAL BLVD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323080589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506561837 | ||||||||
| FaxNumber: | 8508772917 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 NE DARTMOOR DR | ||||||||
| Address2: | |||||||||
| City: | WAUKEE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502639616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159876267 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2014 | ||||||||
| LastUpdateDate: | 08/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 31599 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.