Provider Demographics
NPI:1649041906
Name:ROSANO, LARISSA RAE (PT)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:RAE
Last Name:ROSANO
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 1:7968 S CRICKETWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-0152
Mailing Address - Country:US
Mailing Address - Phone:520-730-2289
Mailing Address - Fax:
Practice Address - Street 1:6011 N ORACLE RD STE 151
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5309
Practice Address - Country:US
Practice Address - Phone:520-561-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT0000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist