Provider Demographics
NPI:1073798906
Name:VASSALLO, DORA ELISA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:ELISA
Last Name:VASSALLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 N UNIVERSITY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3611
Mailing Address - Country:US
Mailing Address - Phone:954-364-4949
Mailing Address - Fax:
Practice Address - Street 1:2231 N UNIVERSITY DR
Practice Address - Street 2:SUITE C
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3611
Practice Address - Country:US
Practice Address - Phone:954-364-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28328225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist