Provider Demographics
NPI:1922575562
Name:WORSDORFER, CASANDRE (MS ATC)
Entity Type:Individual
Prefix:
First Name:CASANDRE
Middle Name:
Last Name:WORSDORFER
Suffix:
Gender:F
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 PRESIDIO POINTE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1591
Mailing Address - Country:US
Mailing Address - Phone:570-460-5746
Mailing Address - Fax:
Practice Address - Street 1:123 PRESIDIO POINTE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25313-1591
Practice Address - Country:US
Practice Address - Phone:570-460-5746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0047642255A2300X
WVAT0015072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer