Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethan Larsen, ATC, LAT

Individual provider Sports Medicine (Neuromusculoskeletal Medicine) Physician · NPI 1295319804

Ethan Larsen, ATC, LAT is a Sports Medicine (Neuromusculoskeletal Medicine) Physician in Provo, Utah. Licensed in Utah. Registered with an NPI since 2021.

Licensed in
UT
In the registry since
2021
What do these letters mean?
ATC — Certified Athletic Trainer
Prevents and treats sport and activity injuries.
LAT — Licensed Athletic Trainer
A state-licensed athletic trainer.

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Practice location Address checks out

1055 N 300 W Ste 410
Provo, UT 84604-3354
Phone: (515) 421-6223
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Neuromusculoskeletal Medicine) Physician (primary) Taxonomy 204C00000X · Licence 12298266-4810 (UT)

Record details

NPI number1295319804
Entity typeIndividual (Type 1)
GenderMale
Credentials ATC , LAT
Sole proprietorNo
NPI enumeratedMay 10, 2021
Last updated in NPPESMay 10, 2021
Certification dateMay 10, 2021

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