Provider Demographics
NPI:1598049215
Name:LAROSA, MICHAEL A (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:LAROSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4804 TRANSIT RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4905
Mailing Address - Country:US
Mailing Address - Phone:716-714-5771
Mailing Address - Fax:716-748-6211
Practice Address - Street 1:4804 TRANSIT RD
Practice Address - Street 2:SUITE 5
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4905
Practice Address - Country:US
Practice Address - Phone:716-714-5771
Practice Address - Fax:716-748-6211
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY015976-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist