Provider Demographics
NPI:1295374874
Name:ROBERTS, CASSANDRA L (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:526 W. GENESEE STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734
Mailing Address - Country:US
Mailing Address - Phone:989-652-2577
Mailing Address - Fax:989-652-4776
Practice Address - Street 1:526 W. GENESEE STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734
Practice Address - Country:US
Practice Address - Phone:989-652-2577
Practice Address - Fax:989-652-4776
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZMT-13075225700000X
MI7501014816225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist