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General NPI Number Information
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NPI Number | 1831065200
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Entity Type | Individual
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Provider Name | SARAH NICHOLE LARSON PTA
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Gender | Female
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 4242 CAMINO DEL RIO N STE 3-5
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City | SAN DIEGO
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State | CA
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Zip | 92108-2611
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Country | US
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Telephone | 619-467-8970
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Fax | 877-298-4204
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Provider Business Mailing Address
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Address Line | 1570 LINBROOK DR
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City | SAN DIEGO
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State | CA
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Zip | 92111-7109
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Country | US
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Telephone | 619-467-8970
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Fax | 877-298-4204
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 6586
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License Number State | CA
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