Healthcare Provider Details

I. General information

NPI: 1003144767
Provider Name (Legal Business Name): MELISSA S LARSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 19TH ST NW
ROCHESTER MN
55901-6606
US

IV. Provider business mailing address

5067 55TH ST NW
ROCHESTER MN
55901-3809
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-3460
  • Fax:
Mailing address:
  • Phone: 507-292-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070012902
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11094
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: