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General NPI Number Information
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NPI Number | 1467831073
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Entity Type | Individual
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Provider Name | IAN MICHAEL LARSON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 4025 E CHANDLER BLVD STE 60
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City | PHOENIX
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State | AZ
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Zip | 85048-8833
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Country | US
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Telephone | 480-417-5271
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 BUTTERFIELD RD STE 1600
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 11525
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number | 11525
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 11525
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License Number State | AZ
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