Provider Demographics
NPI:1144483801
Name:DEPIETRO, LARA SILVIA (LMT)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:SILVIA
Last Name:DEPIETRO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 12TH ST
Mailing Address - Street 2:SUITE # 7
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9497
Mailing Address - Country:US
Mailing Address - Phone:541-991-1181
Mailing Address - Fax:
Practice Address - Street 1:1525 12TH ST
Practice Address - Street 2:SUITE # 7
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9497
Practice Address - Country:US
Practice Address - Phone:541-991-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11651172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist