ETHAN LARSEN

PROVO, UT
NPI1295319804
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy204C00000X Neuromusculoskeletal Medicine, Sports Medicine
(Licence: UT  12298266-4810)
Enumeration Date2021-05-10
Last Update Date2021-05-10
Business Address
ETHAN LARSEN ATC, LAT
1055 N 300 W STE 410
PROVO, UT 84604-3354
Phone number: 515-421-6223
Mailing Address
ETHAN LARSEN ATC, LAT
273 W 590 N
VINEYARD, UT 84059-4812
Phone number: 515-421-6223