Provider Demographics
NPI:1649582123
Name:CASSIDY, PAZ RUTH (MA 37721)
Entity Type:Individual
Prefix:MS
First Name:PAZ
Middle Name:RUTH
Last Name:CASSIDY
Suffix:
Gender:F
Credentials:MA 37721
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12350 ROCKLEDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4812
Mailing Address - Country:US
Mailing Address - Phone:954-257-8193
Mailing Address - Fax:
Practice Address - Street 1:12350 ROCKLEDGE CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4812
Practice Address - Country:US
Practice Address - Phone:954-257-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37721225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist