Provider Demographics
NPI:1780653477
Name:GROSS, CASSIE J (ATC)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:J
Last Name:GROSS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SW 34TH ST.
Mailing Address - Street 2:APT. T184
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:605-695-3678
Mailing Address - Fax:
Practice Address - Street 1:930 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:FL
Practice Address - Zip Code:32619-2388
Practice Address - Country:US
Practice Address - Phone:352-463-3232
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 19802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer