MEDICARE: SANDRA RITKO LARSEN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P920	NC

General Provider Information

NPI Number	:	1154647279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA RITKO LARSEN PT

Provider Business Mailing Address
First Line	:	PO BOX 601529
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1529
Country	:	US
Telephone Number	:	704-316-1900
Fax Number	:	704-316-1924

Provider Business Practice Location Address
First Line	:	125 BALDWIN AVE
Second Line	:	SUITE 100
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3364
Country	:	US
Telephone Number	:	704-316-1900
Fax Number	:	704-316-1924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2010
Last Update Date	:	04/14/2010

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Directions to “ SANDRA RITKO LARSEN PT” Practice Location

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