Healthcare Provider Details

I. General information

NPI: 1700361078
Provider Name (Legal Business Name): NICHOLAS LARGHI PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GALISTEO ST
SANTA FE NM
87505-4747
US

IV. Provider business mailing address

471 SPORTSMANS CIR
REEDS SPRING MO
65737-7490
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-8313
  • Fax:
Mailing address:
  • Phone: 401-243-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT33717
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2023-2375
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: