=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518761048
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARTHUR LASSEE LMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2025
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4758 S ATLANTIC AVE UNIT 3
-----------------------------------------------------
City | PONCE INLET
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32127-7184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-289-8546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4758 S ATLANTIC AVE UNIT 3
-----------------------------------------------------
City | PONCE INLET
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32127-7184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-289-8546
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA106590
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------