Basic Information
| Provider Information | |||||||||
| NPI: | 1770001307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARAIA | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | LAT, ATC, CSCS, EMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 LANGLEY ROAD | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7747668418 | ||||||||
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| Practice Location | |||||||||
| Address1: | 680 CENTRE STREET | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089417000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2017 | ||||||||
| LastUpdateDate: | 09/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 2702 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.