Provider Demographics
NPI:1740288927
Name:LARSON, DAVID E (MSPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:LARSON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RICHMOND SQ
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-433-4172
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:63 MELCHER ST STE 100
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-1534
Practice Address - Country:US
Practice Address - Phone:857-250-4597
Practice Address - Fax:857-305-0482
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA 27096OtherHARVARD PILGRIM GROUP #
MAY67685OtherBC/BS PROVIDER NUMBER
MALA Y68280Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER