Provider Demographics
NPI:1972032902
Name:BELFIORE, CARISSA JINNELL (PTA/LMT)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:JINNELL
Last Name:BELFIORE
Suffix:
Gender:F
Credentials:PTA/LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S 24TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3552
Mailing Address - Country:US
Mailing Address - Phone:412-512-4478
Mailing Address - Fax:
Practice Address - Street 1:117 THREE SPRINGS DR # B
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3827
Practice Address - Country:US
Practice Address - Phone:304-723-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2017-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009936225200000X
WVPTA002036225200000X
PAMSG003803225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant