Individual
BENJAMIN R LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
603 E CARLSON ST STE 304, CHEYENNE, WY 82009-4443
(307) 514-9999
(307) 514-6006
Mailing address
1406 W MAIN ST, RIVERTON, WY 82501-3239
(307) 463-0462
(307) 463-2010
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1325
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129616700
—
WY
Enumeration date
06/08/2010
Last updated
09/30/2021
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