Provider Demographics
NPI:1649689951
Name:CASCALLARES, BRYAN ANDRE' (LMT)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ANDRE'
Last Name:CASCALLARES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 W WISE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3814
Mailing Address - Country:US
Mailing Address - Phone:847-584-0532
Mailing Address - Fax:
Practice Address - Street 1:537 W WISE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3814
Practice Address - Country:US
Practice Address - Phone:847-584-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL586708-10225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist