Provider Demographics
NPI:1427309061
Name:LARSON, CHAD (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:LARSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 MARLOWE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2654
Mailing Address - Country:US
Mailing Address - Phone:216-539-2451
Mailing Address - Fax:
Practice Address - Street 1:6001 COCHRAN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3310
Practice Address - Country:US
Practice Address - Phone:216-539-2451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-23
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.013785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist