Provider Demographics
NPI:1144873290
Name:CAPORUSCIO, LARISSA
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:CAPORUSCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 GIVLER DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16662-1635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:437 GIVLER DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1635
Practice Address - Country:US
Practice Address - Phone:814-793-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant