Provider Demographics
NPI:1437375656
Name:LARSON, KRISTINE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MARIE
Last Name:LARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:MARIE
Other - Last Name:ISAACSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:217 S BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1303
Mailing Address - Country:US
Mailing Address - Phone:785-213-3369
Mailing Address - Fax:
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-7808
Practice Address - Country:US
Practice Address - Phone:316-836-4700
Practice Address - Fax:316-836-4750
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist