Provider Demographics
NPI:1124538558
Name:FLORENO, CASSANDRA LEIGH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:LEIGH
Last Name:FLORENO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8460 KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2334
Mailing Address - Country:US
Mailing Address - Phone:586-868-3669
Mailing Address - Fax:
Practice Address - Street 1:1821 N CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4237
Practice Address - Country:US
Practice Address - Phone:248-631-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist