Provider Demographics
NPI:1861447328
Name:IARUSSO, RINA M (MPT)
Entity Type:Individual
Prefix:MISS
First Name:RINA
Middle Name:M
Last Name:IARUSSO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25843 MARITIME CIR N
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3071
Mailing Address - Country:US
Mailing Address - Phone:925-487-3530
Mailing Address - Fax:
Practice Address - Street 1:20225 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1769
Practice Address - Country:US
Practice Address - Phone:313-882-6419
Practice Address - Fax:313-882-6470
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7122225100000X
MI5501012012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist