ETHAN LARSEN ATC LAT NPI 1295319804

NPI Information

  • NPI: 1295319804
  • Provider Name: ETHAN LARSEN, ATC, LAT
  • Classification: Neuromusculoskeletal Medicine, Sports Medicine - 204C00000X
  • Entity Type: Individual
  • Address: 1055 N 300 W STE 410
    PROVO, UT
    ZIP 84604
  • Phone: (515) 421-6223

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NPI Details

Ethan Larsen, ATC, LAT is a neuromusculoskeletal medicine sports medicine in Provo, UT. The provider is 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/ Ethan Larsen, ATC, LAT NPI is 1295319804. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1055 N 300 W STE 410
PROVO, UT
ZIP 84604-354
Phone: (515) 421-6223

The enumeration date for this NPI number is 5/10/2021 and was last updated on 5/10/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1204C00000XNeuromusculoskeletal Medicine, Sports Medicine12298266-4810UTAHYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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