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NPI Code Detail

MEDICARE: WHITNEY LARSON MS, ATC

MEDICARE: WHITNEY LARSON MS, ATC
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1285140129
Entity Type Code : Individual
Provider Name (Legal Business Name) : WHITNEY LARSON MS, ATC
Provider Business Mailing Address
First Line : 715 NORTH AVE
Second Line :
City : NEW ROCHELLE
State : NY
Zip : 10801-1830
Country : US
Telephone Number : 914-633-2333
Fax Number :
Provider Business Practice Location Address
First Line : 715 NORTH AVE
Second Line :
City : NEW ROCHELLE
State : NY
Zip : 10801-1830
Country : US
Telephone Number : 914-633-2333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2017
Last Update Date : 12/14/2017

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