Provider Demographics
NPI:1538410964
Name:LARUSSO, DASIA LYNN (PT)
Entity type:Individual
Prefix:MRS
First Name:DASIA
Middle Name:LYNN
Last Name:LARUSSO
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 1:203 LINDEN PONDS WAY
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-8700
Mailing Address - Country:US
Mailing Address - Phone:781-534-7382
Mailing Address - Fax:
Practice Address - Street 1:203 LINDEN PONDS WAY
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-8700
Practice Address - Country:US
Practice Address - Phone:781-534-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist