Provider Demographics
NPI:1114465317
Name:TESSITORE, KASSANDRA (PT)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:
Last Name:TESSITORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SAGAMORE TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-1606
Mailing Address - Country:US
Mailing Address - Phone:609-234-7009
Mailing Address - Fax:
Practice Address - Street 1:4756 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6553
Practice Address - Country:US
Practice Address - Phone:954-946-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist