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Ethan Larsen, ATC,LAT
Sports Medicine (Neuromusculoskeletal Medicine) Physician in Provo, Utah
NPI 1295319804

Ethan Larsen is a Sports Medicine (Neuromusculoskeletal Medicine) Physician based in Vineyard, UT. Ethan Larsen practices in Provo, UT and has the professional credentials of ATC,LAT. The NPI Number for Ethan Larsen is 1295319804 and holds a License No. 12298266-4810 (Utah).

The current practice location address for Ethan Larsen is 1055 N 300 W Ste 410, Provo, UT and can be reached out via phone at 515-421-6223.

Location: 1055 N 300 W Ste 410, Provo, UT, 84059-4812
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1295319804
Provider Name
Ethan Larsen
Credential
ATC,LAT
Provider Entity Type
Individual
Gender
Male
Address
1055 N 300 W Ste 410, Provo, UT, 84059-4812
Phone Number
515-421-6223
Fax Number
Provider Enumeration Date
05/10/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1055 N 300 W Ste 410
City
Provo
State
Utah
Zip
84604-3354
Phone Number
515-421-6223
Fax Number
person
Provider Business Mailing Address Details
Address
1055 N 300 W Ste 410
City
Provo
State
Utah
Zip
84604-3354
Phone Number
515-421-6223
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Neuromusculoskeletal Medicine, Sports Medicine
Speciality
-
Taxonomy
204C00000X
License No.
12298266-4810 (Utah)
Definition
Definition to come.
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