Individual
ANDREW LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, MS, CMI
Contact information
Practice address
1515 PARK AVE, COLUMBUS, WI 53925-2402
(920) 623-2200
Mailing address
1515 PARK AVE, COLUMBUS, WI 53925-2402
(920) 623-2200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13415-24
WI
Other
Enumeration date
07/17/2019
Last updated
03/13/2024
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