Provider Demographics
NPI:1316973266
Name:LARSEN, RICHARD CARL (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CARL
Last Name:LARSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6276-024225100000X
MN6286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B17211048332OtherPREFERRED ONE
MN81G96LAOtherBCBS
WI6406071OtherMEDICA
1316973266OtherAM PPO
WI36101900Medicaid
5751300001OtherDMERC
HP61189OtherHEALTHPARTNERS
182849OtherUCARE
P00424481OtherRR MEDICARE
P00424481OtherRR MEDICARE
5751300001OtherDMERC
WI36101900Medicaid