Organization
GAPVIEWPTW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW LUKE LARSON (OWNER, PT)
(402) 802-2054
Entity
Organization
Contact information
Practice address
13 W POTOMAC ST, BRUNSWICK, MD 21716-1112
(301) 401-1276
Mailing address
3623 FRY RD, JEFFERSON, MD 21755-7408
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
09/09/2024
Last updated
10/11/2024
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