Provider Demographics
NPI:1326139460
Name:BASS, STEVEN MITCHELL
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MITCHELL
Last Name:BASS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 WOODGROVE HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-4841
Mailing Address - Country:US
Mailing Address - Phone:561-702-7402
Mailing Address - Fax:561-375-6564
Practice Address - Street 1:8627 WOODGROVE HARBOR LN
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4841
Practice Address - Country:US
Practice Address - Phone:561-702-7402
Practice Address - Fax:561-375-6564
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1341Medicare PIN