Active NPI
Mary Jo Larson
- Physical Therapist
- Hazen, ND
National Provider Identifier
1821206475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 235
- Practice address
- 510 8TH Ave NE
Hazen, ND 58545-4637 - Phone
- (701) 748-2225
- Fax
- (701) 748-5757
- NPI assigned
- May 18, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 235 | ND | Primary |
Addresses
Primary practice location
510 8TH Ave NE
Hazen, ND 58545-4637
Mailing address
510 8TH Ave NE
Hazen, ND 58545-4637
Phone (701) 748-2225
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25572 | Other | ND | BCBS NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 235 | ND | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821206475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 8TH AVE NE",
"city": "HAZEN",
"state": "ND",
"postal_code": "585454637",
"telephone_number": "701-748-2225",
"fax_number": "701-748-5757"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 8TH AVE NE",
"city": "HAZEN",
"state": "ND",
"postal_code": "585454637",
"telephone_number": "701-748-2225",
"fax_number": "701-748-5757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "MARY JO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ND",
"license": "235",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NUMBER",
"identifier": "25572",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hazen, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.