Individual
MRS. EMILY LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
32 CARLSON AVE, REXBURG, ID 83440-1914
(208) 550-8827
Mailing address
32 CARLSON AVE, REXBURG, ID 83440-1914
(208) 550-8827
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAS-1466
ID
Other
Enumeration date
02/03/2014
Last updated
02/03/2014
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