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General NPI Number Information
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NPI Number | 1811062847
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Entity Type | Individual
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Provider Name | ZANE LARSON PT, DPT, ECS, OCS
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 1600 W UNIVERSITY AVE #106
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3114
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Country | US
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Telephone | 928-526-3031
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 W UNIVERSITY AVE #106
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3114
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Country | US
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Telephone | 928-526-3031
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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 | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology Physical Therapist
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License Number | 5758
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 5758
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License Number State | AZ
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