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Individual
BRANDON LARSON
Active
Individual
BRANDON LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
2795-19
WI
Other
Enumeration date
11/15/2018
Last updated
11/15/2018
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