Individual
NATHAN LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, AT, ATC
Contact information
Practice address
601 QUINCY ST., ATHLETICS / PAAVO NURMI GYM, HANCOCK, MI 49930-4993
(906) 487-7532
(906) 487-7527
Mailing address
600 MACINNES DR STE 201, HOUGHTON, MI 49931-1144
(906) 487-7532
(906) 487-7527
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
2601000209
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2601000209
STATE LICENSURE
MI
Enumeration date
04/06/2018
Last updated
04/06/2018
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