Provider Demographics
NPI:1487298147
Name:BASCOS, JAMIECA DEL PILAR (BSPT)
Entity type:Individual
Prefix:
First Name:JAMIECA
Middle Name:DEL PILAR
Last Name:BASCOS
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 SAWGRASS CORPORATE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2869
Mailing Address - Country:US
Mailing Address - Phone:954-298-2207
Mailing Address - Fax:
Practice Address - Street 1:101 W 92 HWY STE H
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:MO
Practice Address - Zip Code:64060-7591
Practice Address - Country:US
Practice Address - Phone:816-903-0777
Practice Address - Fax:816-903-0776
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06147225100000X
MO2019036732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist