Provider Demographics
NPI:1992870059
Name:LARGE, EMILY S (PT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:S
Last Name:LARGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:K
Other - Last Name:LARGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1311
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33402-1311
Mailing Address - Country:US
Mailing Address - Phone:561-762-3105
Mailing Address - Fax:561-828-0924
Practice Address - Street 1:718 KANUGA DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7222
Practice Address - Country:US
Practice Address - Phone:561-762-3105
Practice Address - Fax:561-828-0924
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist