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General NPI Number Information
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NPI Number | 1528219094
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Entity Type | Individual
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Provider Name | JESSICA LEE LASSITER DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 3 LAFAYETTE AVE MARK MORRIS WELLNESS CENTER
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City | BROOKLYN
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State | NY
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Zip | 11217-1415
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Country | US
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Telephone | 347-687-2756
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Fax |
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Provider Business Mailing Address
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Address Line | 423 COURT ST APT 1
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City | BROOKLYN
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State | NY
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Zip | 11231-4590
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Country | US
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Telephone | 347-687-2756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305205605
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36001318A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 032661
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License Number State | NY
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