Healthcare Provider Details

I. General information

NPI: 1528564846
Provider Name (Legal Business Name): DANIEL LARSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 W PENTAGON PL
SIOUX FALLS SD
57107-1104
US

IV. Provider business mailing address

2215 W PENTAGON PL
SIOUX FALLS SD
57107-1104
US

V. Phone/Fax

Practice location:
  • Phone: 605-312-7804
  • Fax:
Mailing address:
  • Phone: 605-312-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number6251
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: