Provider Demographics
NPI:1427362326
Name:BOSSE, CASSANDRE
Entity Type:Individual
Prefix:
First Name:CASSANDRE
Middle Name:
Last Name:BOSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11720 MEDLOCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1509
Mailing Address - Country:US
Mailing Address - Phone:770-622-4000
Mailing Address - Fax:801-853-4404
Practice Address - Street 1:11720 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1509
Practice Address - Country:US
Practice Address - Phone:770-622-4000
Practice Address - Fax:801-853-4404
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT005141225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist