Provider Demographics
NPI:1528398716
Name:MCAVOY, CASSANDRA HOPE (MS, PTA, ATC)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:HOPE
Last Name:MCAVOY
Suffix:
Gender:F
Credentials:MS, PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 N MECKLENBURG AVE
Mailing Address - Street 2:P.O. BOX 217
Mailing Address - City:LA CROSSE
Mailing Address - State:VA
Mailing Address - Zip Code:23950-1768
Mailing Address - Country:US
Mailing Address - Phone:434-447-3322
Mailing Address - Fax:434-447-3282
Practice Address - Street 1:1187 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23950
Practice Address - Country:US
Practice Address - Phone:434-447-3322
Practice Address - Fax:434-447-3282
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260002342255A2300X
VA2306603047225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2306603047OtherVA LICENSE
VA0126000234OtherVA LICENSE NUMBER