Provider Demographics
NPI:1770812661
Name:LARSON, MALORIE ANN (DPT)
Entity type:Individual
Prefix:DR
First Name:MALORIE
Middle Name:ANN
Last Name:LARSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MALORIE
Other - Middle Name:ANN
Other - Last Name:DOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4220 132ND ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:7315 212TH ST SW
Practice Address - Street 2:SUITE 104
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7610
Practice Address - Country:US
Practice Address - Phone:425-774-3226
Practice Address - Fax:425-670-1406
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60122259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0368933OtherL & I
WA4518930OtherAETNA
WA0260899OtherDEPARTMENT OF LABOR AND INDUSTRIES
WA0369225OtherL & I
WA616182300OtherFEDERAL DEPARTMENT OF LABOR
WA0991DOOtherREGENCE
WA12036365OtherCAQH
WA12036365OtherCIGNA