Individual
BROOKE MARIE LARSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4530 NORTHERN SKY DR, BISMARCK, ND 58503
(701) 751-6336
Mailing address
4530 NORTHERN SKY DR, BISMARCK, ND 58503
(701) 751-6336
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
2255A2300X
ND
Other
Enumeration date
03/20/2015
Last updated
04/16/2019
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