Individual
MR. JOHN JEFFREY LARSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LAT, ATC,CSCS
Contact information
Practice address
6701 N JEAN NICOLET RD, MILWAUKEE, WI 53217-3701
(414) 351-8154
Mailing address
108 W FRANSEE LN, SAUKVILLE, WI 53080-1714
(262) 268-9869
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
205-039
WI
Other
Enumeration date
05/16/2006
Last updated
07/08/2007
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