Healthcare Provider Details

I. General information

NPI: 1275403081
Provider Name (Legal Business Name): SANDY LARSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 E 5900 S
MURRAY UT
84107-5421
US

IV. Provider business mailing address

14114 S MILL CANYON PEAK DR
RIVERTON UT
84096-6421
US

V. Phone/Fax

Practice location:
  • Phone: 801-210-0127
  • Fax:
Mailing address:
  • Phone: 801-860-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number13205332-2402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: