Most Relevant Information
Provider Data
| NPI Number: | 1003806795 |
| Provider Name: | SUSAN MANZ LARSON MD |
| Entity Type: | Individual |
| Taxonomy Code: | 208100000X |
| Specialty: | Physical Medicine & Rehabilitation |
| License Number: | 31194020 |
Most Important Dates
| Enumeration Date: | 10/25/2005 |
| Last Updated: | 01/16/2008 |
Provider Practice Location
2424 S 90TH ST
SUITE 500
WEST ALLIS
WI
532272455
Practice Location Phone/Fax
| Phone: | 4143288600 |
| Fax: | 4143288686 |
Provider Mailing Location
19475 W NORTH AVE
SUITE 201
BROOKFIELD
WI
530454199
Provider Mailing Phone/Fax
| Phone: | 2627804400 |
| Fax: | 2627804425 |