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Individual

MS. KIMBERLY LARSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
30980 SCOTT PARK RD TRLR 72, LONG GROVE, IA 52756-9641
(563) 210-1308
Mailing address
30980 SCOTT PARK RD TRLR 72, LONG GROVE, IA 52756-9641

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
01072
IA
225200000X
Physical Therapy Assistant
160004520
IL
225200000X
Physical Therapy Assistant
2014009194
MO

Other

Enumeration date
04/14/2014
Last updated
04/14/2014
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