Provider Demographics
NPI:1710217609
Name:CORNISH, CASSIDY STAMPFER (LMT)
Entity Type:Individual
Prefix:MS
First Name:CASSIDY
Middle Name:STAMPFER
Last Name:CORNISH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:CORNISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:708 E SENECA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6855
Mailing Address - Country:US
Mailing Address - Phone:510-717-4663
Mailing Address - Fax:
Practice Address - Street 1:7827 N DALE MABRY HWY
Practice Address - Street 2:103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3288
Practice Address - Country:US
Practice Address - Phone:813-443-5354
Practice Address - Fax:813-443-5455
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56256225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist