Provider Demographics
NPI:1699052076
Name:LAROSA, CLARE H (PT)
Entity type:Individual
Prefix:MRS
First Name:CLARE
Middle Name:H
Last Name:LAROSA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 MIDDLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1918
Mailing Address - Country:US
Mailing Address - Phone:516-383-2675
Mailing Address - Fax:516-883-0262
Practice Address - Street 1:1474 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1918
Practice Address - Country:US
Practice Address - Phone:516-383-2675
Practice Address - Fax:516-883-0262
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015141-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist