Miranda Cathleen Larson, BCTMB, LMT
Massage Therapist in Fargo, ND. Individual provider (NPI-1).
NPI number1437460334
StatusActive
Last updated in NPPESApr 25, 2017
Details
- NPI
- 1437460334
- Entity type
- Individual (NPI-1)
- Name
- Miranda Cathleen Larson
- Credential
- BCTMB, LMT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 24, 2010
- Last updated
- Apr 25, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 1539 | ND | Yes |
Other names
- Miranda Cathleen Hendrickson (Former Name)
Practice location
112 University Dr NSte 316
Fargo, ND 58102-4661
Phone 218-289-0276
Mailing address
112 University Dr NSte 316
Fargo, ND 58102-4661
Phone 218-289-0276
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