Provider Demographics
NPI:1437427754
Name:LARSON, SUSAN MADELEINE (PT)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MADELEINE
Last Name:LARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:MADELEINE
Other - Last Name:VODDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1146 FERN ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1036
Mailing Address - Country:US
Mailing Address - Phone:303-601-1378
Mailing Address - Fax:
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 5500 N2PT
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:720-402-3801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist