Provider Demographics
NPI:1265745095
Name:LARSON, KATHY LYNN (RRT)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LYNN
Last Name:LARSON
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 NW 48TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2203
Mailing Address - Country:US
Mailing Address - Phone:386-566-1569
Mailing Address - Fax:
Practice Address - Street 1:3846 MOUNTCLIFFE CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-1429
Practice Address - Country:US
Practice Address - Phone:386-566-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00025135227900000X
FLRT6515227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered