Individual
JEFFREY LARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
3604 BEMIDJI AVE N, BEMIDJI, MN 56601-4333
(218) 333-5263
Mailing address
PO BOX MC, FARGO, ND 58122-0605
(701) 234-1261
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5421
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649591942
—
MN
Enumeration date
06/21/2010
Last updated
11/01/2010
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