Healthcare Provider Details

I. General information

NPI: 1144672965
Provider Name (Legal Business Name): CORINNE GRASSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 S POWERLINE RD
POMPANO BEACH FL
33069-4300
US

IV. Provider business mailing address

551 MAPLE DR
MARGATE FL
33063-4536
US

V. Phone/Fax

Practice location:
  • Phone: 954-975-0771
  • Fax:
Mailing address:
  • Phone: 954-446-4409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA14095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: