Provider Demographics
NPI:1417937277
Name:HASSETT, ROBERT BLENNER III (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BLENNER
Last Name:HASSETT
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:526 BAYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6501
Mailing Address - Country:US
Mailing Address - Phone:707-468-5001
Mailing Address - Fax:
Practice Address - Street 1:3101 S STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-6938
Practice Address - Country:US
Practice Address - Phone:707-468-3844
Practice Address - Fax:707-468-5702
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 1381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT10810Medicare ID - Type Unspecified