Provider Demographics
NPI:1598158354
Name:WORMINGTON, LARRY JAMES
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JAMES
Last Name:WORMINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 DEWBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-3022
Mailing Address - Country:US
Mailing Address - Phone:214-763-1177
Mailing Address - Fax:
Practice Address - Street 1:2500 DEWBERRY CT
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-3022
Practice Address - Country:US
Practice Address - Phone:214-763-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care