Individual
MR. JASON JOSEPH LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED., ATC, EMT
Contact information
Practice address
2500 MAIN ST, LAWRENCEVILLE, NJ 08648-1600
(609) 895-2037
(609) 620-7634
Mailing address
PO BOX 6562, LAWRENCEVILLE, NJ 08648-0562
(609) 620-7606
(609) 620-7634
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00097100
NJ
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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