Provider Demographics
NPI:1912619248
Name:HOUSER, CASSIDY
Entity Type:Individual
Prefix:MISS
First Name:CASSIDY
Middle Name:
Last Name:HOUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 W RIVER DRIVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410
Mailing Address - Country:US
Mailing Address - Phone:361-654-4747
Mailing Address - Fax:361-654-4750
Practice Address - Street 1:3921 W RIVER DRIVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410
Practice Address - Country:US
Practice Address - Phone:361-654-4747
Practice Address - Fax:361-654-4750
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT135883225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist