Healthcare Provider Details

I. General information

NPI: 1972424992
Provider Name (Legal Business Name): LARRY RICHARD VAWTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CLEARVIEW XING
SPARTA MI
49345-8220
US

IV. Provider business mailing address

50 CLEARVIEW XING
SPARTA MI
49345-8220
US

V. Phone/Fax

Practice location:
  • Phone: 616-634-1035
  • Fax: 616-205-5012
Mailing address:
  • Phone: 616-634-1035
  • Fax: 616-205-5012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502001657
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: