Provider Demographics
NPI:1023655693
Name:GASSNER, DAVID (LMT, CLT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GASSNER
Suffix:
Gender:M
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WHITE GATE RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1502
Mailing Address - Country:US
Mailing Address - Phone:203-885-3331
Mailing Address - Fax:
Practice Address - Street 1:325 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4230
Practice Address - Country:US
Practice Address - Phone:203-707-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT009561OtherSTATE LICENSE