Healthcare Provider Details

I. General information

NPI: 1083535876
Provider Name (Legal Business Name): JADE E LARSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JADE LARSON

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 ALMA ST STE 200
PALO ALTO CA
94306-3508
US

IV. Provider business mailing address

56 DUDLEY LN APT 102
STANFORD CA
94305-7167
US

V. Phone/Fax

Practice location:
  • Phone: 650-323-4440
  • Fax:
Mailing address:
  • Phone: 910-922-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: