Individual
MS. MARY ST. JOHN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT,CMTPT
Contact information
Practice address
2301 PARK AVE, #209, ORANGE PARK, FL 32073-5565
(904) 215-9923
Mailing address
2301 PARK AVE, #209, ORANGE PARK, FL 32073-5565
(904) 215-9923
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 39861
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C4073
BCBSF
FL
Enumeration date
02/26/2007
Last updated
12/05/2013
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