Provider Demographics
NPI:1134497555
Name:FASONE, THOMAS JOSEPH (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:FASONE
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730354
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-0354
Mailing Address - Country:US
Mailing Address - Phone:386-258-7900
Mailing Address - Fax:386-898-0459
Practice Address - Street 1:290 CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE B-2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8130
Practice Address - Country:US
Practice Address - Phone:386-258-7900
Practice Address - Fax:386-898-0459
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-14579174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist