Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1003935313 |
---|---|
Provider Name | Linda Larson |
First Address | Burnsville, MN 55337-4590 |
Second Address | Burnsville, MN 55337-2537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 05/12/2018 |