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Individual
TIMOTHY A LARSON
Active
Individual
TIMOTHY A LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MAPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00006179
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093715377
NPI
WA
05
—
7081896
—
WA
01
—
GAB00169
MEDICARE OLD PIN
WA
Enumeration date
07/28/2005
Last updated
09/26/2016
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