Individual
BRENT H LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
709 RIVARD ST, SOMERSET, WI 54025-7382
(715) 247-5735
(715) 247-5738
Mailing address
7581 9TH ST N, SUITE 100, OAKDALE, MN 55128-6626
(651) 748-4338
(651) 748-2892
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7714
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40462000
—
WI
Enumeration date
06/02/2006
Last updated
02/14/2008
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