Individual
LARRY JORDAN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT DPT
Contact information
Practice address
1345 CENTER DR STE 100, MEDFORD, OR 97501-7945
(541) 210-5674
(541) 210-5674
Mailing address
1345 CENTER DR STE 100, MEDFORD, OR 97501-7945
(541) 324-6712
(541) 210-5674
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
64546
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64546
OREGON BOARD OF PHYSICAL THERAPY
OR
Enumeration date
06/01/2022
Last updated
06/01/2022
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