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General NPI Number Information
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NPI Number | 1649370230
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Entity Type | Individual
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Provider Name | SARA LOUISE LARSON A.T.,C.
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Gender | Female
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Dates
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Enumeration Date | 09/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1316 5TH ST
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City | SNOHOMISH
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State | WA
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Zip | 98290-2712
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Country | US
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Telephone | 360-563-4085
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Fax |
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Provider Business Mailing Address
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Address Line | 9131 190TH AVE SE
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City | SNOHOMISH
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State | WA
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Zip | 98290-3219
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Country | US
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Telephone | 360-568-2770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 880940
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License Number State | WA
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