Provider Demographics
NPI:1053672931
Name:COCHRAN, CASSIE (PTA)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:COCHRAN
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 1:109 BLUEBIRD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2101
Mailing Address - Country:US
Mailing Address - Phone:903-563-2730
Mailing Address - Fax:
Practice Address - Street 1:400 NORTH KAUFMAN
Practice Address - Street 2:400A
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75457
Practice Address - Country:US
Practice Address - Phone:903-563-2730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2075189225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant