Provider Demographics
NPI:1922080514
Name:TASSO, KAY HOUCK (PT PHD)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:HOUCK
Last Name:TASSO
Suffix:
Gender:F
Credentials:PT PHD
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Mailing Address - Street 1:2245 PLANTATION CENTER DR STE 57
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4311
Mailing Address - Country:US
Mailing Address - Phone:904-374-1414
Mailing Address - Fax:877-736-3470
Practice Address - Street 1:2245 PLANTATION CENTER DR STE 57
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4311
Practice Address - Country:US
Practice Address - Phone:904-374-1414
Practice Address - Fax:877-736-3470
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY003GZMedicare ID - Type Unspecified