Individual
BRENDON LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.A.
Contact information
Practice address
326 CHARDONNAY AVE, PROSSER, WA 99350-9515
(509) 786-6626
Mailing address
326 CHARDONNAY AVE, PROSSER, WA 99350-9515
(509) 786-6626
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
4839
ID
225200000X
Physical Therapy Assistant
Primary
P160719840
WA
Other
Enumeration date
01/18/2017
Last updated
01/19/2017
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