Provider Demographics
NPI:1881623262
Name:LARSEN, ALLEN MICHAEL JR (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:MICHAEL
Last Name:LARSEN
Suffix:JR
Gender:M
Credentials:MS, ATC
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Mailing Address - Street 1:1761 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8841
Mailing Address - Country:US
Mailing Address - Phone:570-387-5121
Mailing Address - Fax:570-389-2099
Practice Address - Street 1:128 NELSON FIELD HOUSE
Practice Address - Street 2:BLOOMSBURG UNIVERSITY
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815
Practice Address - Country:US
Practice Address - Phone:570-389-4369
Practice Address - Fax:570-389-2099
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer