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NPI Code Detail

MEDICARE: OMARI VASSELL PTA

MEDICARE: OMARI VASSELL PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantPTA28792FL

General Provider Information

NPI Number : 1295359578
Entity Type Code : Individual
Provider Name (Legal Business Name) : OMARI VASSELL PTA
Provider Business Mailing Address
First Line : 1834 ADVENTURE PL
Second Line :
City : NORTH LAUDERDALE
State : FL
Zip : 33068-5436
Country : US
Telephone Number : 954-856-7832
Fax Number :
Provider Business Practice Location Address
First Line : 1834 ADVENTURE PL
Second Line :
City : NORTH LAUDERDALE
State : FL
Zip : 33068-5436
Country : US
Telephone Number : 954-856-7832
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2020
Last Update Date : 06/03/2020

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Directions to “ OMARI VASSELL PTA” Practice Location

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