Provider Demographics
NPI:1972065688
Name:VASSEL'S LLC
Entity type:Organization
Organization Name:VASSEL'S LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEAD PEDORTHIST
Authorized Official - Prefix:
Authorized Official - First Name:JAQUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:CPED, BOCPD
Authorized Official - Phone:314-885-0359
Mailing Address - Street 1:10421 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2342
Mailing Address - Country:US
Mailing Address - Phone:314-885-0359
Mailing Address - Fax:314-474-0208
Practice Address - Street 1:10421 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-2342
Practice Address - Country:US
Practice Address - Phone:314-885-0359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty