Individual
MRS. ALEXANDRA RENEE LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
5156 WHIPPLE AVE NW, CANTON, OH 44718-2663
(330) 478-1752
(330) 478-1763
Mailing address
5156 WHIPPLE AVE NW, CANTON, OH 44718-2663
(330) 478-1752
(330) 478-1763
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT 013783
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3055563
—
OH
Enumeration date
07/27/2012
Last updated
07/27/2012
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