Provider Demographics
NPI:1518325927
Name:LORUSSO, GABRIELLE (MS ATC)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:LORUSSO
Suffix:
Gender:F
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6533 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:NY
Mailing Address - Zip Code:14085-9733
Mailing Address - Country:US
Mailing Address - Phone:716-430-1164
Mailing Address - Fax:
Practice Address - Street 1:6533 BURKE RD
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:NY
Practice Address - Zip Code:14085-9733
Practice Address - Country:US
Practice Address - Phone:716-430-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer