Provider Demographics
NPI:1336726165
Name:GRAY, CASSANDRA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:CABLE
Mailing Address - State:WI
Mailing Address - Zip Code:54821-0442
Mailing Address - Country:US
Mailing Address - Phone:715-580-0747
Mailing Address - Fax:
Practice Address - Street 1:8274 E SAN RD
Practice Address - Street 2:
Practice Address - City:SOUTH RANGE
Practice Address - State:WI
Practice Address - Zip Code:54874-8621
Practice Address - Country:US
Practice Address - Phone:715-398-3523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist