MEDICARE: TIMOTHY A LARSON MAPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00006179	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	GAB00169	OTHER	WA	MEDICARE OLD PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1093715377	OTHER	WA	NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093715377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY A LARSON MAPT

Provider Business Mailing Address
First Line	:	PO BOX 1122
Second Line	:
City	:	OMAK
State	:	WA
Zip	:	98841-1122
Country	:	US
Telephone Number	:	509-826-9533
Fax Number	:	509-826-1152

Provider Business Practice Location Address
First Line	:	11 N. MAIN ST.
Second Line	:
City	:	OMAK
State	:	WA
Zip	:	98841
Country	:	US
Telephone Number	:	509-826-9533
Fax Number	:	509-826-1152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	09/26/2016

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Directions to “ TIMOTHY A LARSON MAPT” Practice Location

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