Provider Demographics
NPI:1851075543
Name:LARSON, ALYSIA ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:ELIZABETH
Last Name:LARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W INDEPENDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-1126
Mailing Address - Country:US
Mailing Address - Phone:401-874-2006
Mailing Address - Fax:401-874-7099
Practice Address - Street 1:25 W INDEPENDENCE WAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1126
Practice Address - Country:US
Practice Address - Phone:401-874-2006
Practice Address - Fax:401-874-7099
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist