Individual
MARK WAYNE LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
10093 SUNNY LN, OOLTEWAH, TN 37363-8487
(423) 838-8906
Mailing address
PO BOX 1505, 10093 SUNNY LANE, COLLEGEDALE, TN 37315-1505
(423) 838-8906
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9061
TN
Other
Enumeration date
04/23/2013
Last updated
04/23/2013
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