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Individual
LARRY JORDAN LARSEN
Active
Individual
LARRY JORDAN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
64546
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64546
OREGON BOARD OF PHYSICAL THERAPY
OR
Enumeration date
06/01/2022
Last updated
06/01/2022
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