MEDICARE: RACHAEL MARY ELIZABETH PHARR 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	PT 21474	CA

General Provider Information

NPI Number	:	1841362894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL MARY ELIZABETH PHARR LARSON P.T.

Provider Business Mailing Address
First Line	:	247 SANTA FE AVE
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-1948
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1851 SHELL BEACH RD STE B
Second Line	:
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-1860
Country	:	US
Telephone Number	:	805-878-9868
Fax Number	:

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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