Provider Demographics
NPI:1558675207
Name:MASSIE-OSBORNE THERAPHY SERVICES, INC.
Entity Type:Organization
Organization Name:MASSIE-OSBORNE THERAPHY SERVICES, INC.
Other - Org Name:MASSIE-OSBORNE THERAPY SERVICES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MASSIE-OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:727-360-6652
Mailing Address - Street 1:133 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:TREASURE ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33706-4715
Mailing Address - Country:US
Mailing Address - Phone:727-360-6652
Mailing Address - Fax:727-363-4428
Practice Address - Street 1:133 107TH AVE
Practice Address - Street 2:
Practice Address - City:TREASURE ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33706-4715
Practice Address - Country:US
Practice Address - Phone:727-360-6652
Practice Address - Fax:727-363-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16875261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9306OtherBCBS
FLE3426Medicare UPIN