Individual
JEFFREY LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT-ATC
Contact information
Practice address
810 N WELO ST, TIOGA, ND 58852-7157
(701) 664-3305
(701) 664-2240
Mailing address
PO BOX 159, TIOGA, ND 58852-0159
(701) 664-3305
(701) 664-2240
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
ND0956
ND
Other
Enumeration date
02/02/2021
Last updated
02/04/2021
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