Provider Demographics
NPI:1467046946
Name:FERDINAND, KASSANDRA ANN (ATC, LAT)
Entity Type:Individual
Prefix:MISS
First Name:KASSANDRA
Middle Name:ANN
Last Name:FERDINAND
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7452 ADMIRAL PEARY HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630-1706
Mailing Address - Country:US
Mailing Address - Phone:814-408-2092
Mailing Address - Fax:
Practice Address - Street 1:7452 ADMIRAL PEARY HWY STE 3
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1706
Practice Address - Country:US
Practice Address - Phone:814-408-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0073922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART007392OtherATHLETIC TRAINER