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General NPI Number Information
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NPI Number | 1083991483
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Entity Type | Organization
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Legal Business Name | LARSON REHAB, PLLC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 4208 SANTA OLIVIA
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City | MISSION
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State | TX
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Zip | 78572-8636
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Country | US
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Telephone | 956-563-9762
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Fax | 956-271-4317
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Provider Business Mailing Address
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Address Line | 4208 SANTA OLIVIA
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City | MISSION
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State | TX
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Zip | 78572-8636
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Country | US
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Telephone | 956-563-9762
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Fax | 956-271-4317
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Authorized Official
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Title or Position | OWNER/ADMIN
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Name | SARAH MARIE LARSON
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Credential | PT
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Telephone | 956-563-9762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1160910
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License Number State | TX
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