Provider Demographics
NPI:1043415086
Name:GEORGE, LARRY MICHAEL (LMT)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:MICHAEL
Last Name:GEORGE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 ROBERTS LN
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1326
Mailing Address - Country:US
Mailing Address - Phone:724-657-9574
Mailing Address - Fax:
Practice Address - Street 1:2730 ELLWOOD RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-6276
Practice Address - Country:US
Practice Address - Phone:724-730-0549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33. 010521225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist