Healthcare Provider Details

I. General information

NPI: 1700979606
Provider Name (Legal Business Name): LORILEE C LARSON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 W 49TH ST STE 103
SIOUX FALLS SD
57106-5221
US

IV. Provider business mailing address

27805 481ST AVE
CANTON SD
57013-5543
US

V. Phone/Fax

Practice location:
  • Phone: 605-951-0417
  • Fax: 605-356-8075
Mailing address:
  • Phone: 320-979-0232
  • Fax: 605-356-8075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1151
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7066
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1151
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: