Provider Demographics
NPI:1932483765
Name:REFORZO, LARISA MARIE (PTA)
Entity Type:Individual
Prefix:MS
First Name:LARISA
Middle Name:MARIE
Last Name:REFORZO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 SPOTSYLVANIA PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-9433
Mailing Address - Country:US
Mailing Address - Phone:540-710-0061
Mailing Address - Fax:
Practice Address - Street 1:4710 SPOTSYLVANIA PKWY STE 102
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9433
Practice Address - Country:US
Practice Address - Phone:540-710-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603104225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant