MEDICARE: RACHEL FEY LARSEN PT

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	1092625	TX

General Provider Information

NPI Number	:	1548351638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL FEY LARSEN PT

Provider Business Mailing Address
First Line	:	123 W FAIR OAKS PL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3708
Country	:	US
Telephone Number	:	210-820-0818
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 BABCOCK RD
Second Line	:	SUITE 204
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4554
Country	:	US
Telephone Number	:	210-342-5300
Fax Number	:	210-342-5325

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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