Provider Demographics
NPI:1003294133
Name:LARSEN, KATHRYN N (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:N
Last Name:LARSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:60 PEMBROKE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2449
Mailing Address - Country:US
Mailing Address - Phone:617-964-3314
Mailing Address - Fax:
Practice Address - Street 1:60 PEMBROKE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2449
Practice Address - Country:US
Practice Address - Phone:617-964-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist