Provider Demographics
NPI:1568712107
Name:CHRISTENSEN, CASSIE B (PTA)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:B
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 110TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:ND
Mailing Address - Zip Code:58490-9325
Mailing Address - Country:US
Mailing Address - Phone:701-866-2576
Mailing Address - Fax:
Practice Address - Street 1:7114 110TH AVE SE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:ND
Practice Address - Zip Code:58490-9325
Practice Address - Country:US
Practice Address - Phone:701-866-2576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1048225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant