# GAPVIEWPTW

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851127708
- **Authorized official:** MATTHEW LUKE LARSON (OWNER, PT)
- **Authorized official phone:** (402) 802-2054

## Contact information

- **Practice address:** 13 W POTOMAC ST, BRUNSWICK, MD 21716-1112
- **Practice address phone:** (301) 401-1276
- **Mailing address:** 3623 FRY RD, JEFFERSON, MD 21755-7408

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 09/09/2024
- **Last updated:** 10/11/2024