Provider Demographics
NPI:1619237039
Name:HASSEMAN, MARK W (LMT, MMP)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:HASSEMAN
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CENTRAL AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631
Mailing Address - Country:US
Mailing Address - Phone:740-446-6800
Mailing Address - Fax:740-446-6800
Practice Address - Street 1:21 CENTRAL AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-446-6800
Practice Address - Fax:740-446-6800
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7732225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$-00OtherOH BWC