Active NPI
Brendon Larsen, P.T.A.
- Physical Therapy Assistant
- Prosser, WA
National Provider Identifier
1922544600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- P160719840
- Practice address
- 326 Chardonnay Ave
Prosser, WA 99350-9515 - Phone
- (509) 786-6626
- NPI assigned
- Jan 18, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 4839 | ID | |
| Physical Therapy Assistant | 225200000X | P160719840 | WA | Primary |
Addresses
Primary practice location
326 Chardonnay Ave
Prosser, WA 99350-9515
Mailing address
326 Chardonnay Ave
Prosser, WA 99350-9515
Phone (509) 786-6626
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 |
|---|---|---|---|
| 4839 | ID | MD | Physical Therapy Assistant |
| P160719840 | WA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484784000000",
"number": "1922544600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "326 CHARDONNAY AVE",
"city": "PROSSER",
"state": "WA",
"postal_code": "993509515",
"telephone_number": "509-786-6626"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "326 CHARDONNAY AVE",
"city": "PROSSER",
"state": "WA",
"postal_code": "993509515",
"telephone_number": "509-786-6626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "BRENDON",
"credential": "P.T.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-01-18",
"last_updated": "2017-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ID",
"license": "4839",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WA",
"license": "P160719840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prosser, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.