MEDICARE: ANTHONY WILLIAM LAREAU PT, 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	PTL.0020410	CO

General Provider Information

NPI Number	:	1548069479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY WILLIAM LAREAU PT, DPT

Provider Business Mailing Address
First Line	:	3490 HAYDEN PL APT 3
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-1932
Country	:	US
Telephone Number	:	608-225-8454
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 MAIN ST UNIT 200
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-5175
Country	:	US
Telephone Number	:	720-497-6162
Fax Number	:	720-497-6723

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

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	03/12/2025

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