Provider Demographics
NPI:1164742052
Name:MAINS, CASSANDRA REGINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:REGINE
Last Name:MAINS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:REGINE
Other - Last Name:CHALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HALSTEAD
Mailing Address - State:KS
Mailing Address - Zip Code:67056-2137
Mailing Address - Country:US
Mailing Address - Phone:316-835-0042
Mailing Address - Fax:316-669-8502
Practice Address - Street 1:232 MAIN ST
Practice Address - Street 2:
Practice Address - City:HALSTEAD
Practice Address - State:KS
Practice Address - Zip Code:67056-1913
Practice Address - Country:US
Practice Address - Phone:316-835-0042
Practice Address - Fax:316-669-8502
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist