Provider Demographics
NPI:1720750268
Name:JONES, CASSANDRA FAYE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:FAYE
Last Name:JONES
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CAUGHMAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-9435
Mailing Address - Country:US
Mailing Address - Phone:803-319-2274
Mailing Address - Fax:
Practice Address - Street 1:120 CAUGHMAN PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-9435
Practice Address - Country:US
Practice Address - Phone:803-319-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist