Provider Demographics
NPI:1043592165
Name:PASETTI, BRYAN KENNETH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:KENNETH
Last Name:PASETTI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18331 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3669
Mailing Address - Country:US
Mailing Address - Phone:954-655-3174
Mailing Address - Fax:
Practice Address - Street 1:2229 N COMMERCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3282
Practice Address - Country:US
Practice Address - Phone:954-659-8986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist