Provider Demographics
NPI:1083863229
Name:LARIOSA, JOSELITO C (PT)
Entity Type:Individual
Prefix:
First Name:JOSELITO
Middle Name:C
Last Name:LARIOSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 CHELLE LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-6009
Mailing Address - Country:US
Mailing Address - Phone:573-634-2997
Mailing Address - Fax:573-634-5836
Practice Address - Street 1:1024 ADAMS ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3408
Practice Address - Country:US
Practice Address - Phone:573-659-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist