Healthcare Provider Details

I. General information

NPI: 1407041577
Provider Name (Legal Business Name): LARISSA MARIE RHODES P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST REHAB SERVICES- TOWER 2C
BOSTON MA
02115-6110
US

IV. Provider business mailing address

53 HAMPSHIRE ST APT 2
CAMBRIDGE MA
02139-1549
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5301
  • Fax:
Mailing address:
  • Phone: 315-559-5208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18018
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: