Provider Demographics
NPI:1609104017
Name:BASSETT, JOHN T V (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:BASSETT
Suffix:V
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 1:2000 MIRROR LAKE BLVD
Mailing Address - Street 2:SUITE S
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-2124
Mailing Address - Country:US
Mailing Address - Phone:770-456-7877
Mailing Address - Fax:706-456-7880
Practice Address - Street 1:2000 MIRROR LAKE BLVD
Practice Address - Street 2:SUITE S
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-2124
Practice Address - Country:US
Practice Address - Phone:770-456-7877
Practice Address - Fax:706-456-7880
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist