Individual
PETER LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
211 E MILL STREET, PELICAN RAPIDS, MN 56572-4234
(218) 863-1140
Mailing address
3608 KENNEDY ST S, FARGO, ND 58104-6416
(701) 235-7860
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6812
LICENSE #
MN
Enumeration date
08/30/2006
Last updated
10/14/2007
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