Provider Demographics
NPI:1215790407
Name:CASSIDY, KATIE (LMT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:CASSIDY
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 1:20 BARKLEY CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4545
Mailing Address - Country:US
Mailing Address - Phone:614-237-6373
Mailing Address - Fax:
Practice Address - Street 1:20 BARKLEY CIR STE 201
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4545
Practice Address - Country:US
Practice Address - Phone:239-245-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty