Provider Demographics
NPI:1700655172
Name:GRANT, CASSANDRA N (LMT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:N
Last Name:GRANT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 GOODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-2436
Mailing Address - Country:US
Mailing Address - Phone:740-415-5220
Mailing Address - Fax:
Practice Address - Street 1:10400 LANCASTER NEWARK RD NE
Practice Address - Street 2:
Practice Address - City:MILLERSPORT
Practice Address - State:OH
Practice Address - Zip Code:43046-8003
Practice Address - Country:US
Practice Address - Phone:740-467-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.023200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist