Healthcare Provider Details

I. General information

NPI: 1740288927
Provider Name (Legal Business Name): DAVID E LARSON MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MELCHER ST STE 100
BOSTON MA
02210-1534
US

IV. Provider business mailing address

4 RICHMOND SQ
PROVIDENCE RI
02906-5117
US

V. Phone/Fax

Practice location:
  • Phone: 857-250-4597
  • Fax: 857-305-0482
Mailing address:
  • Phone: 401-433-4172
  • Fax: 401-433-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12053
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: