Provider Demographics
NPI:1922232008
Name:PRATT, FAYSSANYA G (LMT)
Entity Type:Individual
Prefix:
First Name:FAYSSANYA
Middle Name:G
Last Name:PRATT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 S ISLES CIR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4406
Mailing Address - Country:US
Mailing Address - Phone:954-793-2813
Mailing Address - Fax:
Practice Address - Street 1:8808 S ISLES CIR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4406
Practice Address - Country:US
Practice Address - Phone:954-793-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33412225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist