Provider Demographics
NPI:1467096271
Name:PISKE, CASSIE M (LMT RYT)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:M
Last Name:PISKE
Suffix:
Gender:F
Credentials:LMT RYT
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:M
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 BUCHANAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 BUCHANAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008
Practice Address - Country:US
Practice Address - Phone:815-985-6323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.012876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty