Individual
DAN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATR, PTA, CSCS
Contact information
Practice address
2090 WOODWINDS DR, WOODBURY, MN 55125-2522
(651) 332-1436
Mailing address
2596 DOROTHY AVE, WHITE BEAR LAKE, MN 55110-4911
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/04/2014
Last updated
09/04/2014
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