Individual
MRS. KELLY MARIE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
10300 W 103RD ST, SUITE 300, OVERLAND PARK, KS 66214-2642
(913) 894-1910
Mailing address
6124 CHARLOTTE ST, KANSAS CITY, MO 64110-3310
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-03354
KS
225100000X
Physical Therapist
20020076797
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-03354
STATE LICENSE
KS
01
—
2002007697
STATE LICENSE
MO
Enumeration date
03/06/2007
Last updated
07/08/2007
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