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General NPI Number Information
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NPI Number | 1780993873
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Entity Type | Individual
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Provider Name | LISA LAROSSA HAID PT
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Gender | Female
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 316 E 88TH ST
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City | NEW YORK
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State | NY
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Zip | 10128-4909
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Country | US
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Telephone | 212-534-3656
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Fax |
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Provider Business Mailing Address
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Address Line | 13 KENT PL
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City | COS COB
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State | CT
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Zip | 06807-2025
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Country | US
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Telephone | 203-869-8350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 007247
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License Number State | NY
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