Individual
JENNIFER L LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT, LMT, CERTDN
Contact information
Practice address
1309 W GUADALUPE RD, SUITE 1, MESA, AZ 85202-9112
(480) 280-9625
(480) 718-7628
Mailing address
1309 W GUADALUPE RD, SUITE 1, MESA, AZ 85202-9112
(480) 280-9625
(480) 718-7628
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9105PT
AZ
225700000X
Massage Therapist
MT-11128
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
560177
—
AZ
Enumeration date
10/01/2010
Last updated
11/06/2014
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