Provider Demographics
NPI:1902234313
Name:BASCO, EMMA MENDOZA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:MENDOZA
Last Name:BASCO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6462 COVEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-1114
Mailing Address - Country:US
Mailing Address - Phone:352-596-7122
Mailing Address - Fax:
Practice Address - Street 1:13719 DALLAS DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7133
Practice Address - Country:US
Practice Address - Phone:727-862-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 10670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist