Provider Demographics
NPI:1720420821
Name:SPASSOFF, ALEX ROBERT (LMT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:ROBERT
Last Name:SPASSOFF
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1508
Mailing Address - Country:US
Mailing Address - Phone:813-259-3404
Mailing Address - Fax:813-434-1284
Practice Address - Street 1:307 N HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1508
Practice Address - Country:US
Practice Address - Phone:813-259-3404
Practice Address - Fax:813-434-1284
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA2936225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist