Provider Demographics
NPI:1316176993
Name:GRASSO, THOMAS (LMT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GRASSO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 FAY BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-8267
Mailing Address - Country:US
Mailing Address - Phone:321-208-3909
Mailing Address - Fax:
Practice Address - Street 1:4795 FAY BLVD STE 10
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-8267
Practice Address - Country:US
Practice Address - Phone:321-208-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-05
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 14343225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist