MEDICARE: PETER LARSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6812	OTHER	MN	LICENSE #

General Provider Information

NPI Number	:	1487763314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER LARSON

Provider Business Mailing Address
First Line	:	PO BOX 415
Second Line	:
City	:	PELICAN RAPIDS
State	:	MN
Zip	:	56572-0415
Country	:	US
Telephone Number	:	218-863-1981
Fax Number	:	218-863-2211

Provider Business Practice Location Address
First Line	:	46 N BROADWAY
Second Line	:
City	:	PELICAN RAPIDS
State	:	MN
Zip	:	56572-4137
Country	:	US
Telephone Number	:	218-863-1981
Fax Number	:	218-863-2211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/05/2026

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Directions to “ PETER LARSON ” Practice Location

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