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ETHAN LARSEN ATC, LAT
NPI 1295319804
Neuromusculoskeletal Medicine, Sports Medicine in Provo, UT

Active since May 10, 2021
1055 N 300 W STE 410, PROVO, UT 84604(515) 421-6223 Get Directions Write a Review

NPPES record last updated: May 10, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Ethan Larsen Atc, Lat NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHAN LARSEN ATC, LAT (NPI 1295319804) is an individual neuromusculoskeletal medicine, sports medicine provider in Provo, Utah, licensed in Utah (12298266-4810) and active in the NPI registry since May 2021.

NPPES Registry Identity

NPI1295319804
Entity TypeIndividualMale
Primary Taxonomy204C00000X
Provider Legal NameETHAN LARSENCredential: ATC, LAT
Location Address1055 N 300 W STE 410Provo, UT 84604-3354
Mailing Address273 W 590 NVineyard, UT 84059-4812 · (515) 421-6223
Phone(515) 421-6223
Sole ProprietorNo
Enumeration DateMay 10, 2021
NPPES CertifiedMay 10, 2021
✔ NPI 1295319804 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNeuromusculoskeletal Medicine, Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code204C00000X
License✔ Licensed in UT · 12298266-4810
Definition
A Neuromusculoskeletal Medicine and Osteopathic Manipulative Medicine physician trained to be responsible for the continuous care in the field of sports medicine encompasses increased knowledge and understanding of osteopathic principles and practice and heightened technical skills of osteopathic manipulative medicine and integrates each of these into the management of the individual engaged in physical exercise (sports) whether as an individual or in team participation. Source: American Osteopathic Association Additional Resources: AOA Osteopathic Board Certification in Neuromusculoskeletal Medicine; https://certification.osteopathic.org/sports-medicine/
1055 N 300 W STE 410, Provo, UT 84604
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Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JODY QUICK WIXOM M.D.
Physical Medicine & Rehabilitation
1055 N 300 W STE 410
PROVO, UT 84604
Utah County (801) 357-8818
JOSIE MARTINEZ ATC
Specialist/Technologist (Athletic Trainer)
1055 N 300 W STE 410
PROVO, UT 84604
Utah County (801) 616-3675
JOSEPH MERRILL ATC
Specialist/Technologist (Athletic Trainer)
1055 N 300 W STE 410
PROVO, UT 84604
Utah County (367) 580-1616
DR. JARED CHRISTENSEN DPT
Physical Therapist
1055 N 300 W STE 410
PROVO, UT 84604
Utah County (801) 616-3675

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Larsen's NPI number?

The NPI number for Ethan Larsen is 1295319804. It was assigned to this individual provider in the NPPES registry on May 10, 2021.

Where is Ethan Larsen located?

Ethan Larsen practices at 1055 N 300 W Ste 410, Provo, UT 84604. The listed phone number is (515) 421-6223.

What is Ethan Larsen's specialty?

The primary specialty registered for this NPI is Neuromusculoskeletal Medicine, Sports Medicine with taxonomy code 204C00000X.

When was this NPI record last updated?

The NPPES record for Ethan Larsen was last updated on May 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.