Individual
MR. ANDREW WILLIAM LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1400 1ST ST NE, NEW PRAGUE, MN 56071-2215
(952) 758-2535
Mailing address
848 RAMSEY AVE, CARVER, MN 55315-4515
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6759
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14N46LA
MN BLUE CROSS BLUE SHIELD
MN
Enumeration date
09/25/2006
Last updated
01/17/2008
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