Provider Demographics
NPI:1285350173
Name:BASS, DAVID B
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:B
Last Name:BASS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W KNOWLTON RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5427
Mailing Address - Country:US
Mailing Address - Phone:215-720-0013
Mailing Address - Fax:
Practice Address - Street 1:235 W KNOWLTON RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5427
Practice Address - Country:US
Practice Address - Phone:215-720-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist