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General NPI Number Information
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NPI Number | 1972065688
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Entity Type | Organization
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Legal Business Name | VASSEL'S LLC
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 10421 W FLORISSANT AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63136-2342
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Country | US
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Telephone | 314-885-0359
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Fax |
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Provider Business Mailing Address
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Address Line | 10421 W FLORISSANT AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63136-2342
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Country | US
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Telephone | 314-885-0359
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Fax | 314-474-0208
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Authorized Official
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Title or Position | OWNER/HEAD PEDORTHIST
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Name | JAQUAN VASSEL
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Credential | C.PED, BOCPD
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Telephone | 314-885-0359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224L00000X
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Taxonomy Name | Pedorthist
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License Number |
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License Number State |
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