Provider Demographics
NPI:1376741306
Name:TASSIN, MARTIN VINCE (PT)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:VINCE
Last Name:TASSIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 HIGHWAY 190 EAST SERVICE RD
Mailing Address - Street 2:E. SERVICE ROAD # 103
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4960
Mailing Address - Country:US
Mailing Address - Phone:985-893-8285
Mailing Address - Fax:985-893-8288
Practice Address - Street 1:7015 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:E. SERVICE ROAD # 103
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4960
Practice Address - Country:US
Practice Address - Phone:985-893-8285
Practice Address - Fax:985-893-8288
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CQ01Medicare PIN