Provider Demographics
NPI:1124746599
Name:KASSAM, JAMIL (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAMIL
Middle Name:
Last Name:KASSAM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 HAROLD PL STE 210
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4555
Mailing Address - Country:US
Mailing Address - Phone:858-755-5200
Mailing Address - Fax:619-870-2693
Practice Address - Street 1:861 HAROLD PL STE 210
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4555
Practice Address - Country:US
Practice Address - Phone:858-755-5200
Practice Address - Fax:619-870-2693
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist