Individual
LORI AUGUSTA LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MESSAGE THERAPIST
Contact information
Practice address
1100 E BANNERMAN AVE # 2, REDGRANITE, WI 54970-9320
(920) 566-0767
(920) 566-0768
Mailing address
PO BOX 447, REDGRANITE, WI 54970-0447
(920) 566-0767
(920) 566-0768
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2116-146
WI
Other
Enumeration date
10/13/2021
Last updated
10/18/2021
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