Organization
LARRY J ASSALITA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY J ASSALITA DPM (PROPRIETOR)
(814) 238-0675
Entity
Organization
Contact information
Practice address
110 REGENT CT, SUITE 200, STATE COLLEGE, PA 16801-7966
(814) 238-0675
(814) 238-8455
Mailing address
110 REGENT CT, SUITE 200, STATE COLLEGE, PA 16801-7966
(814) 238-0675
(814) 238-8455
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
SC002410-L
PA
332BC3200X
Customized Equipment (DME)
SC002410-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0867765
—
PA
01
—
862816801
TRICARE
—
Enumeration date
12/27/2007
Last updated
10/25/2012
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