Provider Demographics
NPI:1033702642
Name:LARSON, ARIANNA LEE (DPT)
Entity Type:Individual
Prefix:
First Name:ARIANNA
Middle Name:LEE
Last Name:LARSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 CLEVELAND ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2330
Mailing Address - Country:US
Mailing Address - Phone:701-337-6095
Mailing Address - Fax:
Practice Address - Street 1:23212 SAINT FRANCIS BLVD NW
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:MN
Practice Address - Zip Code:55070-2300
Practice Address - Country:US
Practice Address - Phone:763-753-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist