Healthcare Provider Details

I. General information

NPI: 1356906846
Provider Name (Legal Business Name): JENNIFER LARKLAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANKLAN LARSON

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 FORD PKWY
SAINT PAUL MN
55116-2799
US

IV. Provider business mailing address

2972 KENOSHA DR NW
ROCHESTER MN
55901-5577
US

V. Phone/Fax

Practice location:
  • Phone: 651-696-5010
  • Fax:
Mailing address:
  • Phone: 507-316-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14574-24
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12091
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: