Provider Demographics
NPI:1073321535
Name:CASS, CHRISTINA (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:CASS
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:W1983 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53178-9622
Mailing Address - Country:US
Mailing Address - Phone:262-297-8027
Mailing Address - Fax:
Practice Address - Street 1:N56W39325 WISCONSIN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2192
Practice Address - Country:US
Practice Address - Phone:262-297-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47-14339225700000X
WIPWA-4550168374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty