Larsen Dunnicliff Physical Therapy Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT86420 Issued in CA

Legal business name

LARSEN DUNNICLIFF PHYSICAL THERAPY INC

Practice address

2087 Grand Canal Blvd
Suite 17
Stockton, CA 95207-6651

Phone

(209) 473-1138

Fax

(209) 473-1891

NPI assigned

Feb 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ronald K Larsen, P.T.NPI 1851489033

Title

Owner

Phone

(209) 473-1138

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ronald Kenneth Larsen, P.T.

  • Physical Therapist
  • Stockton, CA
  • NPI 1851489033
  Medicare reassignment Care Compare group NPD Authorized official
• Gregory Dean Dunnicliff, P.T.

  • Physical Therapist
  • Stockton, CA
  • NPI 1295823409
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226880000000",
    "number": "1093840407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2087 GRAND CANAL BLVD",
            "address_2": "SUITE 17",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076651",
            "telephone_number": "209-473-1138",
            "fax_number": "209-473-1891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2087 GRAND CANAL BLVD",
            "address_2": "SUITE 17",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076651",
            "telephone_number": "209-473-1138",
            "fax_number": "209-473-1891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARSEN DUNNICLIFF PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2008-11-17",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "209-473-1138",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "PT66770",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "PT86420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650011088",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650008773",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexander A Largaespada, LMFT
• Larisa Kouperschmidt MD LLC
• Sherry A. Larkin, LCSW
• Zion Larkins
• Jasmine Larose
• Asia Kay Larsen
• Kimberly W. Larsen, MD
• Ronald Kenneth Larsen, P.T.
• Tori Larsen
• Jeffery Scott Larson Jr.

• Specialist in Stockton, CA
• Providers in Stockton, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.