MEDICARE: LORILEE C LARSON P.T.

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	1151	SD
2	225100000X	Physical Therapist	7066	MN
3	2251P0200X	Pediatric Physical Therapist	1151	SD

General Provider Information

NPI Number	:	1700979606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORILEE C LARSON P.T.

Provider Business Mailing Address
First Line	:	27805 481ST AVE
Second Line	:
City	:	CANTON
State	:	SD
Zip	:	57013-5543
Country	:	US
Telephone Number	:	320-979-0232
Fax Number	:	605-356-8075

Provider Business Practice Location Address
First Line	:	4009 W 49TH ST STE 103
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-5221
Country	:	US
Telephone Number	:	605-951-0417
Fax Number	:	605-356-8075

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/22/2024

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