Provider Demographics
NPI:1407822471
Name:ST. CLAIR, KASANDRA BOWLES (DPT)
Entity Type:Individual
Prefix:MS
First Name:KASANDRA
Middle Name:BOWLES
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S MAIN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6600
Mailing Address - Country:US
Mailing Address - Phone:540-552-3422
Mailing Address - Fax:540-552-2296
Practice Address - Street 1:1901 S MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6600
Practice Address - Country:US
Practice Address - Phone:540-552-3422
Practice Address - Fax:540-552-2296
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00381063OtherMEDICARE RAILROAD
VI7961679OtherAETNA
VT193617OtherANTHEM
VI7961679OtherAETNA