Healthcare Provider Details

I. General information

NPI: 1548274855
Provider Name (Legal Business Name): BRIAN A LARKIN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 POINTE CIR
GREENVILLE SC
29615-3505
US

IV. Provider business mailing address

77 POINTE CIR
GREENVILLE SC
29615-3505
US

V. Phone/Fax

Practice location:
  • Phone: 864-233-4477
  • Fax: 864-233-7844
Mailing address:
  • Phone: 864-233-4477
  • Fax: 864-233-7844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4679
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: