Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
ETHAN LARSEN, ATC, LAT
ActiveETHAN LARSEN, ATC, LAT is a Neuromusculoskeletal Medicine & OMM healthcare provider located in PROVO, Utah. NPI 1295319804 is currently active in the NPPES registry. Verify at CMS.
Neuromusculoskeletal Medicine & OMM · PROVO, UT
Registration Details
- NPI Number
- 1295319804
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 10, 2021 (5.2218377020929 yrs)
- Last Updated
- May 10, 2021
- License
-
12298266-4810 (UT)
Practice Information
- Address
-
1055 N 300 W STE 410PROVO, UT, 846043354Browse UT providers · Browse ZIP 84604
- Phone
- 5154216223
- Primary Specialty
-
Neuromusculoskeletal Medicine & OMM
204C00000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.