Paul Erik Larson, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT002358A Issued in PA

Practice address

101 Brooklyn Street/Business Route 6
Carbondale, PA 18407

Phone

(570) 282-4500

Fax

(570) 281-7102

NPI assigned

May 11, 2009

Last updated

May 11, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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": "1242000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242000000000",
    "number": "1417181082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "673 GREAT BEND TPKE",
            "city": "PLEASANT MOUNT",
            "state": "PA",
            "postal_code": "184534544",
            "telephone_number": "570-448-2598",
            "fax_number": "570-281-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BROOKLYN STREET/BUSINESS ROUTE 6",
            "city": "CARBONDALE",
            "state": "PA",
            "postal_code": "18407",
            "telephone_number": "570-282-4500",
            "fax_number": "570-281-7102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "PAUL",
        "middle_name": "ERIK",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-11",
        "last_updated": "2009-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT002358A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lincoln Ave Medical

• Athletic Trainer in Carbondale, PA
• Providers in Carbondale, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2009; 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.