Provider Demographics
NPI:1831396001
Name:VANDEVER LUND, CASSANDRA LEA (PT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEA
Last Name:VANDEVER LUND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:PARKERFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67005-6631
Mailing Address - Country:US
Mailing Address - Phone:620-506-8864
Mailing Address - Fax:620-442-4089
Practice Address - Street 1:1320 WHEAT RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-4704
Practice Address - Country:US
Practice Address - Phone:620-221-4660
Practice Address - Fax:620-221-1999
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS176538Medicare ID - Type UnspecifiedMEDICARE