Provider Demographics
NPI:1437745395
Name:NORMAN, CASSONDRA JOANNE (CMT)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:JOANNE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11439 MAGNOLIA AVE APT 160
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-4895
Mailing Address - Country:US
Mailing Address - Phone:909-225-3067
Mailing Address - Fax:
Practice Address - Street 1:11439 MAGNOLIA AVE APT 160
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-4895
Practice Address - Country:US
Practice Address - Phone:909-225-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79657225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist