Provider Demographics
NPI:1336339613
Name:ANNESE, LARA M (PT)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:M
Last Name:ANNESE
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 1:2021 K ST NW
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1003
Mailing Address - Country:US
Mailing Address - Phone:202-463-7611
Mailing Address - Fax:202-463-7669
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:SUITE 500
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-463-7611
Practice Address - Fax:202-463-7669
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-96712251X0800X
DCPT870883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00519Medicare UPIN