Provider Demographics
NPI:1114290129
Name:LARSEN, CAITLIN (DPT)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 RIDGEWAY DR STE 3
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2023
Mailing Address - Country:US
Mailing Address - Phone:319-665-2630
Mailing Address - Fax:
Practice Address - Street 1:3290 RIDGEWAY DR STE 3
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2023
Practice Address - Country:US
Practice Address - Phone:319-665-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004881208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation