MEDICARE: MRS. KRISTINE MARIE LARSON P.T.

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	1103681	KS

General Provider Information

NPI Number	:	1437375656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINE MARIE LARSON P.T.

Provider Business Mailing Address
First Line	:	217 S BELMONT ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-1303
Country	:	US
Telephone Number	:	785-213-3369
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:
City	:	NEWTON
State	:	KS
Zip	:	67114-7808
Country	:	US
Telephone Number	:	316-836-4700
Fax Number	:	316-836-4750

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	04/26/2010

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