Miranda Cathleen Larson, BCTMB, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

1539 Issued in ND

Practice address

112 University Dr N
Ste 316
Fargo, ND 58102-4661

Phone

(218) 289-0276

NPI assigned

Jun 24, 2010

Last updated

Apr 25, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miranda Cathleen Hendrickson Former 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": "1277337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493078400000",
    "number": "1437460334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 UNIVERSITY DR N",
            "address_2": "STE 316",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024661",
            "telephone_number": "218-289-0276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 UNIVERSITY DR N",
            "address_2": "STE 316",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024661",
            "telephone_number": "218-289-0276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "MIRANDA",
        "middle_name": "CATHLEEN",
        "credential": "BCTMB, LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-24",
        "last_updated": "2017-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "ND",
            "license": "1539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "HENDRICKSON",
            "middle_name": "CATHLEEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimberlie Larson, RN, BSN
• Loni Larson, LICSW
• Mary F Larson, LRD, MPH
• Megan Elizabeth Larson, APRN, CNP
• Michael Larson
• Nicole Andrea Larson, MS, LPC, LPCC
• Robin S Larson, RN
• Sarah Mae Larson, PHARMD
• Sophia Larson
• Sydney Larson, LAPC

• Massage Therapist in Fargo, ND
• Providers in Fargo, ND by specialty
• Massage Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; 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.