Individual
MARK LARAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
430 5TH ST N, BRECKENRIDGE, MN 56520-1426
(218) 641-7725
(218) 641-6625
Mailing address
430 5TH ST N, BRECKENRIDGE, MN 56520-1426
(218) 641-7725
(218) 641-6625
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10615
MN
225100000X
Physical Therapist
3626
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1470616
—
ND
Enumeration date
07/28/2016
Last updated
06/30/2022
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