Provider Demographics
NPI:1033836382
Name:WOODS, CASSANDRA E (PTA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:E
Last Name:WOODS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64053-1504
Mailing Address - Country:US
Mailing Address - Phone:816-213-1179
Mailing Address - Fax:
Practice Address - Street 1:530 S CEDAR AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64053-1504
Practice Address - Country:US
Practice Address - Phone:816-213-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006001836225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006001836OtherDIVISION OF PROFESSIONAL REGISTRY STATE OF MO