Provider Demographics
NPI:1699123109
Name:TOMASSI, MODESTINO (DPT)
Entity type:Individual
Prefix:DR
First Name:MODESTINO
Middle Name:
Last Name:TOMASSI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 ANCHOR WAY
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34946-1902
Mailing Address - Country:US
Mailing Address - Phone:772-979-4630
Mailing Address - Fax:
Practice Address - Street 1:351 ANCHOR WAY
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34946-1902
Practice Address - Country:US
Practice Address - Phone:772-979-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist