Provider Demographics
NPI:1164813523
Name:LA ROSA, CAROL (BS, LMT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:LA ROSA
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 EMPIRE BLVD APT 60
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2172
Mailing Address - Country:US
Mailing Address - Phone:585-671-7333
Mailing Address - Fax:
Practice Address - Street 1:1729 EMPIRE BLVD APT 60
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2172
Practice Address - Country:US
Practice Address - Phone:585-671-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017881-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist