Provider Demographics
NPI:1548041965
Name:LARRISON, MICHAELA ERIN (PT)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ERIN
Last Name:LARRISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 BIGGERS FARM CT
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8829
Mailing Address - Country:US
Mailing Address - Phone:704-668-1146
Mailing Address - Fax:
Practice Address - Street 1:1008 BIGGERS FARM CT
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-8829
Practice Address - Country:US
Practice Address - Phone:704-668-1146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP22523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist