Provider Demographics
NPI:1689169740
Name:PRICE, CASSI RAE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CASSI
Middle Name:RAE
Last Name:PRICE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 OHIO ST STE B10
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3529
Mailing Address - Country:US
Mailing Address - Phone:812-870-8748
Mailing Address - Fax:
Practice Address - Street 1:401 OHIO ST STE B10
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3529
Practice Address - Country:US
Practice Address - Phone:812-870-8748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21605968225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist