Individual
ANN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
312 1ST AVE W, CLARK, SD 57225-1405
(605) 532-4212
Mailing address
312 1ST AVE W, CLARK, SD 57225-1405
(605) 532-4212
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1194
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21256
SVC HEALTHPLAN
SD
01
—
4997989
BCBS OF SD
SD
05
—
5833542
—
SD
01
—
7079
AVERA HEALTHPLAN
SD
Enumeration date
01/17/2007
Last updated
10/20/2009
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