Provider Demographics
NPI:1326407073
Name:NASSIF, SAM Y I
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:Y
Last Name:NASSIF
Suffix:I
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 1:2554 BIG PINE DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-8778
Mailing Address - Country:US
Mailing Address - Phone:727-512-7532
Mailing Address - Fax:
Practice Address - Street 1:2554 BIG PINE DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-8778
Practice Address - Country:US
Practice Address - Phone:727-512-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24820225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant