Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 005108 | IA |
NPI | 1013444546 |
---|---|
Provider Name | Jennifer Lynn Larsen |
First Address | Cedar Rapids, IA 52402-6353 |
Second Address | Cedar Rapids, IA 52402-6353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2017 |
Last Update Date | 15/05/2017 |