Provider Demographics
NPI:1932538386
Name:RIES, CASSANDRA (LMP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:RIES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32856 20TH AVE S
Mailing Address - Street 2:UNIT B
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6430
Mailing Address - Country:US
Mailing Address - Phone:253-324-8345
Mailing Address - Fax:
Practice Address - Street 1:530 S 336TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6383
Practice Address - Country:US
Practice Address - Phone:253-874-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60404058283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0289955556OtherAMTA