Provider Demographics
NPI:1245372630
Name:PHILLIPS, CASSANDRA GAY (ATC)
Entity type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:GAY
Last Name:PHILLIPS
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 1:25 MAUDIE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-2213
Mailing Address - Country:US
Mailing Address - Phone:864-294-3657
Mailing Address - Fax:
Practice Address - Street 1:FURMAN UNIVERSITY 3300 POINSETT HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29613-0001
Practice Address - Country:US
Practice Address - Phone:864-294-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer