Individual
ANDREW LARSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4675 BLUESTEM RD, ROSCOE, IL 61073-7788
(815) 623-9930
(815) 623-9931
Mailing address
2905 WARE RD, ROCKFORD, IL 61114-6592
(815) 229-1412
(815) 623-9931
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IL
Other
Enumeration date
11/07/2006
Last updated
07/08/2007
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