Provider Demographics
NPI:1699899575
Name:LARSEN, DIANE (PT)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8926 ARBOR HILL DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2100
Mailing Address - Country:US
Mailing Address - Phone:219-796-7273
Mailing Address - Fax:219-972-2830
Practice Address - Street 1:8926 ARBOR HILL DR
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2100
Practice Address - Country:US
Practice Address - Phone:219-796-7273
Practice Address - Fax:219-972-2830
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist