Mary St. John Larson, LMT,CMTPT

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA 39861 Issued in FL

Practice address

2301 Park Ave
#209
Orange Park, FL 32073-5565

Phone

(904) 215-9923

NPI assigned

Feb 26, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Muscle Matters Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386201600000",
    "number": "1043346687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 PARK AVE",
            "address_2": "#209",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735565",
            "telephone_number": "904-215-9923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 PARK AVE",
            "address_2": "#209",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735565",
            "telephone_number": "904-215-9923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "MARY",
        "middle_name": "ST. JOHN",
        "name_prefix": "Ms.",
        "credential": "LMT,CMTPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2013-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "MA 39861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSF",
            "identifier": "C4073",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MUSCLE",
            "last_name": "MATTERS",
            "credential": "CMTPT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Melissa Ann Lara, LMHC, BCBA
• Brenda Lee Larosee, APRN
• Larry L Han Inc Dba Acupuncture Treatment Center
• Dianne Larson, ARNP
• Lanah W Larson, RN
• Zachary Larson, LMHC
• Paul M. Lasala, C.O.T.A
• Junior Lashley
• Timothy A Lattimore, NURSE PRACTITIONER
• Caitlin Laurence

• Specialist in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.