Brenda Joy Larson Pittacora, PTA

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

160001451 Issued in IL

Practice address

412 W 31St St
Chicago, IL 60616-3116

Phone

(312) 225-3119

Fax

(312) 225-3219

NPI assigned

Jun 1, 2010

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sports and Ortho P.C

  • Rehabilitation Clinic/Center
  • Chicago, IL
  • NPI 1871640565
  NPD (past)

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

{
    "created_epoch": "1275350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1275350400000",
    "number": "1760701791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 W 31ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163116",
            "telephone_number": "312-225-3119",
            "fax_number": "312-225-3219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 W 31ST ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163116",
            "telephone_number": "312-225-3119",
            "fax_number": "312-225-3219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON PITTACORA",
        "first_name": "BRENDA",
        "middle_name": "JOY",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-01",
        "last_updated": "2010-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "160001451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Payton Larsen, ALMFT
• Timothy Raymond Larsen, D.O.
• Victoria Larsen, APRN
• Victoria Larsen
• Larson Counseling & Consultation, P.C.
• Carla Jeanne Larson-Hunter, RPH
• Alexis Larson, NP-C
• Amber Larson
• Candice Larson, M.S.
• Caroline Ann Larson

• Physical Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2010; 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.