Individual
ELIZABETH LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5535 S WILLIAMSON BLVD, STE 774, PORT ORANGE, FL 32128-8311
(800) 330-7711
Mailing address
4 E 3RD ST, CORNING, NY 14830-3112
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6769
SC
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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