Provider Demographics
NPI:1669015806
Name:LASSO, ASHLYN
Entity Type:Individual
Prefix:
First Name:ASHLYN
Middle Name:
Last Name:LASSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 GREENGLEN CIR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3018
Mailing Address - Country:US
Mailing Address - Phone:561-504-8294
Mailing Address - Fax:
Practice Address - Street 1:2307 S DALE MABRY HWY STE F
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6322
Practice Address - Country:US
Practice Address - Phone:813-374-9508
Practice Address - Fax:813-443-5599
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35213225100000X
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist