Provider Demographics
NPI:1093943797
Name:CASSANO, LAURIE ANN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:CASSANO
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-2418
Mailing Address - Country:US
Mailing Address - Phone:516-581-5957
Mailing Address - Fax:
Practice Address - Street 1:10 YARMOUTH RD
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-2418
Practice Address - Country:US
Practice Address - Phone:516-581-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019452-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor