Organization
LASALLE UNIVERSITY
Active
Other names
LaSalle Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MOUZON BASS (ADMINISTRATOR)
(972) 367-4845
Entity
Organization
Contact information
Practice address
1900 W OLNEY AVE, PHILADELPHIA, PA 19141-1108
(972) 367-4845
Mailing address
5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Enumeration date
04/30/2018
Last updated
04/30/2018
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