Provider Demographics
NPI:1962656363
Name:PASERO, ROBERT JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:PASERO
Suffix:
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 1:1707 WARREN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-2939
Mailing Address - Country:US
Mailing Address - Phone:318-267-1996
Mailing Address - Fax:
Practice Address - Street 1:1707 WARREN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2939
Practice Address - Country:US
Practice Address - Phone:318-267-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05136R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist