Provider Demographics
NPI:1952623266
Name:LAROW, BRENDA VIRGINIA (ATC)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:VIRGINIA
Last Name:LAROW
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 STAFFORD ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1422
Mailing Address - Country:US
Mailing Address - Phone:518-527-4043
Mailing Address - Fax:
Practice Address - Street 1:964 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-1310
Practice Address - Country:US
Practice Address - Phone:774-354-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22OtherRESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS