Provider Demographics
NPI:1326524547
Name:MIKE YASSON LLC
Entity Type:Organization
Organization Name:MIKE YASSON LLC
Other - Org Name:BIG LEAGUE PERFORMANCE AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:YASSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DPT, CSCS
Authorized Official - Phone:631-806-3554
Mailing Address - Street 1:1525 HALF ST SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3412
Mailing Address - Country:US
Mailing Address - Phone:631-806-3554
Mailing Address - Fax:
Practice Address - Street 1:1525 HALF ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3412
Practice Address - Country:US
Practice Address - Phone:631-806-3554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT871868261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy