Provider Demographics
NPI:1922238971
Name:ELLIS, LARISSA (DPT)
Entity type:Individual
Prefix:MRS
First Name:LARISSA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:
Other - Last Name:RODRIGUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:7825 CREST DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5614
Mailing Address - Country:US
Mailing Address - Phone:303-252-5086
Mailing Address - Fax:
Practice Address - Street 1:315 SOUTH BOULDER RD STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-4855
Practice Address - Country:US
Practice Address - Phone:303-666-4151
Practice Address - Fax:303-666-4166
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO104392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic