Provider Demographics
NPI:1114468204
Name:KASSAR, JOANNA (PT,DPT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:KASSAR
Suffix:
Gender:F
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 1:4035 MISSION OAKS BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5156
Mailing Address - Country:US
Mailing Address - Phone:805-497-9411
Mailing Address - Fax:
Practice Address - Street 1:4035 MISSION OAKS BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5156
Practice Address - Country:US
Practice Address - Phone:805-497-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063745842Medicare PIN