Individual
KYLE ANTHONY LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
417 3RD AVENUE, CLEAR LAKE, WI 54005-8905
(715) 263-4103
(715) 263-4110
Mailing address
PO BOX 147, CLEAR LAKE, WI 54005-0147
(715) 263-4103
(715) 263-4110
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
14996-24
WI
Other
Enumeration date
05/27/2020
Last updated
05/27/2020
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