Provider Demographics
NPI:1588855829
Name:LASSLO, PATTI DENISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:DENISE
Last Name:LASSLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 OAKHURST AVE
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1633
Mailing Address - Country:US
Mailing Address - Phone:606-436-4119
Mailing Address - Fax:
Practice Address - Street 1:1017 OAKHURST AVE
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1633
Practice Address - Country:US
Practice Address - Phone:606-436-4119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist