Provider Demographics
NPI:1114611290
Name:LARSON, ANNA MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:LARSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 E PACIFIC DR
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3033
Mailing Address - Country:US
Mailing Address - Phone:801-855-6101
Mailing Address - Fax:801-980-0510
Practice Address - Street 1:999 E PACIFIC DR
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-3033
Practice Address - Country:US
Practice Address - Phone:801-855-6101
Practice Address - Fax:801-980-0510
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6827325-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty