Provider Demographics
NPI:1245648880
Name:MILLER, CASSANDRA A (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W ARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4828
Mailing Address - Country:US
Mailing Address - Phone:518-461-5515
Mailing Address - Fax:
Practice Address - Street 1:5859 HARBOUR VIEW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3015
Practice Address - Country:US
Practice Address - Phone:757-686-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1245648880OtherMEDICAID QMB
VAC05954OtherMEDICARE GROUP PTAN
VAQ47559AMedicare PIN