Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 070012902 | IL |
Y | 225100000X | Physical Therapist | 11094 | MN |
NPI | 1003144767 |
---|---|
Provider Name | Melissa S Larson |
First Address | Rochester, MN 55901-3809 |
Second Address | Rochester, MN 55901-3809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2009 |
Last Update Date | 10/06/2021 |