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NPI Code Detail

MEDICARE: MS. ILENE LINDA LARSON PHYSICAL THERAPIST

MEDICARE: MS. ILENE LINDA LARSON PHYSICAL THERAPIST
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
1225100000XPhysical Therapist1236-024WI

General Provider Information

NPI Number : 1528122009
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ILENE LINDA LARSON PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 2620 WAUNONA WAY
Second Line :
City : MADISON
State : WI
Zip : 53713-1525
Country : US
Telephone Number : 608-223-1452
Fax Number :
Provider Business Practice Location Address
First Line : 2620 WAUNONA WAY
Second Line :
City : MADISON
State : WI
Zip : 53713-1525
Country : US
Telephone Number : 608-223-1452
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 07/08/2007

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