MEDICARE: TERRY TENNILLE LARSON MESSMER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT21685	FL

General Provider Information

NPI Number	:	1518909043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY TENNILLE LARSON MESSMER DPT

Provider Business Mailing Address
First Line	:	12334 JILLIAN CIR
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34669-5001
Country	:	US
Telephone Number	:	727-505-8144
Fax Number	:

Provider Business Practice Location Address
First Line	:	12334 JILLIAN CIR
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34669-5001
Country	:	US
Telephone Number	:	727-505-8144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	11/17/2016

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