Individual
BENJAMIN LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, PT
Contact information
Practice address
515 22ND AVE, MONROE, WI 53566-1569
(608) 324-1178
Mailing address
312 MAPLE ST, LENA, IL 61048-9129
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12668-24
WI
Other
Enumeration date
08/14/2014
Last updated
08/14/2014
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