Healthcare Provider Details

I. General information

NPI: 1659310845
Provider Name (Legal Business Name): SANDRA K LARSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 MONTGOMERY ST
DECORAH IA
52101-2720
US

IV. Provider business mailing address

704 RIDGE RD
DECORAH IA
52101-1120
US

V. Phone/Fax

Practice location:
  • Phone: 563-382-4770
  • Fax: 563-382-4785
Mailing address:
  • Phone: 563-382-4770
  • Fax: 563-382-4785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number03565
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number03565
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier34900
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBLUE CROSS BLUE SHEILD
# 2
IdentifierF245962
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerMIDLANDS CHOICE
# 3
IdentifierTN0100
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerJOHN DEERE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: