Provider Demographics
NPI:1710152475
Name:JANNISE, CASSIE LAIRD
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:LAIRD
Last Name:JANNISE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CASSIE
Other - Middle Name:SUZANNE
Other - Last Name:LAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2335 CHURCH ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2700
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-654-4642
Practice Address - Street 1:2335 CHURCH ST
Practice Address - Street 2:SUITE G
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2700
Practice Address - Country:US
Practice Address - Phone:225-654-8208
Practice Address - Fax:225-654-4642
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist