MEDICARE: MS. JANET LARSON

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1780027425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET LARSON

Provider Business Mailing Address
First Line	:	44777 N HILLS DR # N119
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48167-2135
Country	:	US
Telephone Number	:	313-274-2720
Fax Number	:

Provider Business Practice Location Address
First Line	:	44777 N HILLS DR APT N119
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48167-2135
Country	:	US
Telephone Number	:	313-274-2720
Fax Number	:

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

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	04/11/2013

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