Provider Demographics
NPI:1437589975
Name:LARSON, ERICA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:LARSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-0519
Mailing Address - Country:US
Mailing Address - Phone:509-999-3733
Mailing Address - Fax:
Practice Address - Street 1:613 S WASHINGTON ST
Practice Address - Street 2:STE 203
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2535
Practice Address - Country:US
Practice Address - Phone:509-999-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60418228225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist