Individual
MRS. KARLA MARIE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
729 PARK ST, ANTIGO, WI 54409-2745
(715) 623-2356
Mailing address
P4803 COUNTY ROAD Z, BIRNAMWOOD, WI 54414-9414
(715) 449-3261
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1952-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952-024
WI PROFESSIONAL PT LICENSE
WI
05
—
40020100
—
WI
Enumeration date
04/22/2008
Last updated
04/22/2008
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