Healthcare Provider Details

I. General information

NPI: 1811534746
Provider Name (Legal Business Name): DANA JO LARKIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OHIO ST
MEDINA NY
14103-1095
US

IV. Provider business mailing address

200 OHIO ST
MEDINA NY
14103-1095
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-2000
  • Fax:
Mailing address:
  • Phone: 585-798-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number045271-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: