Provider Demographics
NPI:1912258583
Name:MASSOPUST, ALLISON (DPT, CFMT)
Entity Type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:
Last Name:MASSOPUST
Suffix:
Gender:F
Credentials:DPT, CFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 EL CAMINO REAL
Mailing Address - Street 2:PHYSICAL THERAPY DEPARTMENT CLARK BUILDING
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2302
Mailing Address - Country:US
Mailing Address - Phone:650-853-3355
Mailing Address - Fax:
Practice Address - Street 1:795 EL CAMINO REAL
Practice Address - Street 2:PHYSICAL THERAPY DEPARTMENT CLARK BUILDING
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2302
Practice Address - Country:US
Practice Address - Phone:650-853-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist