Individual
MIRANDA LYNN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT NMT
Contact information
Practice address
1380 LEAD HILL BLVD STE 211, ROSEVILLE, CA 95661-2997
(916) 530-0029
Mailing address
1380 LEAD HILL BLVD STE 211, ROSEVILLE, CA 95661-2997
(916) 530-0029
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
88128
CA
Other
Enumeration date
12/29/2022
Last updated
02/07/2024
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