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General NPI Number Information
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NPI Number | 1326524547
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Entity Type | Organization
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Legal Business Name | MIKE YASSON LLC
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 1525 HALF ST SW
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City | WASHINGTON
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State | DC
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Zip | 20024-3412
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Country | US
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Telephone | 631-806-3554
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 HALF ST SW
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City | WASHINGTON
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State | DC
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Zip | 20024-3412
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Country | US
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Telephone | 631-806-3554
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | DR. RAYMOND MICHAEL YASSON III
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Credential | DPT, CSCS
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Telephone | 631-806-3554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT871868
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License Number State | DC
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