Individual
MACKENZIE A LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
218 4TH ST, FORT LUPTON, CO 80621-2016
(303) 710-0903
Mailing address
218 4TH ST, FORT LUPTON, CO 80621-2016
(303) 710-0903
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/08/2021
Last updated
11/08/2021
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