Provider Demographics
NPI:1275394512
Name:DUNLAP, CASSANDRA (PTA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CAASSANDRA
Other - Middle Name:
Other - Last Name:LOAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:17990 CHAPEL HILL CT
Mailing Address - Street 2:
Mailing Address - City:TUOLUMNE
Mailing Address - State:CA
Mailing Address - Zip Code:95379-9782
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1311 SANGUINETTI RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-6210
Practice Address - Country:US
Practice Address - Phone:209-694-3870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49459225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant