Provider Demographics
NPI:1467600858
Name:LARSON, ANNA RAE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:RAE
Last Name:LARSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:RAE
Other - Last Name:DOUBEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3345 COLTON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0252
Mailing Address - Country:US
Mailing Address - Phone:406-513-1422
Mailing Address - Fax:406-513-1127
Practice Address - Street 1:3345 COLTON DR
Practice Address - Street 2:SUITE A
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0252
Practice Address - Country:US
Practice Address - Phone:406-513-1422
Practice Address - Fax:406-513-1127
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2131225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist