Individual
RYAN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3155 CHANNING WAY STE D, IDAHO FALLS, ID 83404-7875
(208) 552-2700
Mailing address
2035 CORTE DEL NOGAL, STE 200, CARLSBAD, CA 92011-1445
(800) 929-4776
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-5873
ID
Other
Enumeration date
01/17/2019
Last updated
01/25/2019
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