1548514318 NPI number — JOHN DANIEL GRASSI MASSAGE THERAPIST

Table of content: JOHN DANIEL GRASSI MASSAGE THERAPIST (NPI 1548514318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548514318 NPI number — JOHN DANIEL GRASSI MASSAGE THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRASSI
Provider First Name:
JOHN
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASSAGE THERAPIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548514318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 W INDIANTOWN RD
Provider Second Line Business Mailing Address:
#102
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-3556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-529-2093
Provider Business Mailing Address Fax Number:
636-582-5897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 W INDIANTOWN RD
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-3556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-529-2093
Provider Business Practice Location Address Fax Number:
636-582-5897
Provider Enumeration Date:
11/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA28516 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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