Provider Demographics
NPI:1942326756
Name:LARSSON, DIANE L (PT, CMT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:LARSSON
Suffix:
Gender:F
Credentials:PT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 EAST WASHINGTON ST., UNIT 23
Mailing Address - Street 2:COMPREHENSIVE THERAPY CENTER
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760
Mailing Address - Country:US
Mailing Address - Phone:508-643-3800
Mailing Address - Fax:508-643-3809
Practice Address - Street 1:500 E WASHINGTON ST UNIT 23
Practice Address - Street 2:COMPREHENSIVE THERAPY CENTER
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-6303
Practice Address - Country:US
Practice Address - Phone:508-643-3800
Practice Address - Fax:508-643-3809
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8800225100000X
RIPT01513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66998OtherBCBS OF MA
RI406546OtherBLUE CHIP
RI21066-7OtherBCBS OF RI
MA307580OtherHARVARD PILGRIM
MA6400276OtherUNITED HEALTHCARE
RI21066-7OtherBCBS OF RI