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NPI Code Detail

MEDICARE: MR. LARRY FURRY PTA

MEDICARE:  MR. LARRY  FURRY  PTA
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
1225200000XPhysical Therapy AssistantAT 2369CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AT2369OTHERCACA PT BOARD

General Provider Information

NPI Number : 1396960779
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LARRY FURRY PTA
Provider Business Mailing Address
First Line : 19531 BEACH BLVD
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-2902
Country : US
Telephone Number : 714-960-7995
Fax Number : 714-960-1884
Provider Business Practice Location Address
First Line : 19531 BEACH BLVD
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-2902
Country : US
Telephone Number : 714-960-7995
Fax Number : 714-960-1884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2007
Last Update Date : 10/05/2007

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Directions to “ MR. LARRY FURRY PTA” Practice Location

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