Provider Demographics
NPI:1417434499
Name:KASSIS, COURTNEY (RD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:KASSIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 SPRING RIDGE DR E
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9577
Mailing Address - Country:US
Mailing Address - Phone:610-739-8440
Mailing Address - Fax:
Practice Address - Street 1:1835 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2968
Practice Address - Country:US
Practice Address - Phone:484-450-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty