Provider Demographics
NPI:1326934068
Name:BURDETTE, CASSIDY MARGARET (BS, ATC)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:MARGARET
Last Name:BURDETTE
Suffix:
Gender:X
Credentials:BS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 GRALAN RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4834
Mailing Address - Country:US
Mailing Address - Phone:410-615-9133
Mailing Address - Fax:
Practice Address - Street 1:180 S FRONTAGE RD W STE 2700
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5038
Practice Address - Country:US
Practice Address - Phone:970-476-7220
Practice Address - Fax:877-546-1181
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00028412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer