NPI 1295319804

Ethan Larsen, ATCLAT

Practitioner Sports Medicine (Neuromusculoskeletal Medicine) Physician Provo, UT

Practice location

Address: 1055 N 300 W STE 410, Provo, UT 84604-3354
Phone: (515) 421-6223
Mailing address: 273 W 590 N, Vineyard, UT 84059-4812

Registered specialties

Sports Medicine (Neuromusculoskeletal Medicine) Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 204C00000X Licence 12298266-4810 (UT)

Other Neuromusculoskeletal Medicine, Sports Medicine providers in Utah →

Registry record

NPI: 1295319804
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 May 2021
Record last updated: 10 May 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.