Provider Demographics
NPI:1891185922
Name:PHILLIPS, CASSANDRA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 COWETT RD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04220-5504
Mailing Address - Country:US
Mailing Address - Phone:207-212-8686
Mailing Address - Fax:
Practice Address - Street 1:52 COWETT RD
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:ME
Practice Address - Zip Code:04220-5504
Practice Address - Country:US
Practice Address - Phone:207-212-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist