Provider Demographics
NPI:1689616542
Name:OVERTON, CASSANDRA D (LPT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:D
Last Name:OVERTON
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 SHANNON WOODS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4103
Mailing Address - Country:US
Mailing Address - Phone:316-858-1900
Mailing Address - Fax:316-858-1914
Practice Address - Street 1:10100 SHANNON WOODS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4103
Practice Address - Country:US
Practice Address - Phone:316-858-1900
Practice Address - Fax:316-858-1914
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist