MEDICARE: MR. LARRY D HINSON R.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT6453	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT6453	OTHER	CA	CA. STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083617336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY D HINSON R.P.T.

Provider Business Mailing Address
First Line	:	18661 OLD COAST HWY
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-8260
Country	:	US
Telephone Number	:	707-964-5645
Fax Number	:	707-964-6213

Provider Business Practice Location Address
First Line	:	18661 OLD COAST HWY
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-8260
Country	:	US
Telephone Number	:	707-964-5645
Fax Number	:	707-964-6213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	11/26/2007

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