Provider Demographics
NPI:1699431551
Name:LEEN, CASSANDRA RENEE (LMT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RENEE
Last Name:LEEN
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 1:3198 NW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4229
Mailing Address - Country:US
Mailing Address - Phone:954-399-1069
Mailing Address - Fax:
Practice Address - Street 1:3198 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33309-4229
Practice Address - Country:US
Practice Address - Phone:954-399-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMASG1306225700000X
FLMA95165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist