Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 9578 | MA |
NPI | 1003294133 |
---|---|
Provider Name | Kathryn N Larsen |
First Address | Newton, MA 02458-2449 |
Second Address | Newton, MA 02458-2449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2015 |
Last Update Date | 21/07/2015 |