Basic Information
| Provider Information | |||||||||
| NPI: | 1770812661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARSON | ||||||||
| FirstName: | MALORIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DOWLING | ||||||||
| OtherFirstName: | MALORIE | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4220 132ND ST SE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980128999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253579380 | ||||||||
| FaxNumber: | 4253579382 | ||||||||
| Practice Location | |||||||||
| Address1: | 7315 212TH ST SW | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257743226 | ||||||||
| FaxNumber: | 4256701406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2009 | ||||||||
| LastUpdateDate: | 04/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 60122259 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0368933 | 01 | WA | L & I | OTHER | 4518930 | 01 | WA | AETNA | OTHER | 0260899 | 01 | WA | DEPARTMENT OF LABOR AND INDUSTRIES | OTHER | 0369225 | 01 | WA | L & I | OTHER | 616182300 | 01 | WA | FEDERAL DEPARTMENT OF LABOR | OTHER | 0991DO | 01 | WA | REGENCE | OTHER | 12036365 | 01 | WA | CAQH | OTHER | 12036365 | 01 | WA | CIGNA | OTHER |