Provider Demographics
NPI:1710876339
Name:SLATE, CASSANDRA (PT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:SLATE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 NE 32ND AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7130
Mailing Address - Country:US
Mailing Address - Phone:305-218-8523
Mailing Address - Fax:
Practice Address - Street 1:5220 S UNIVERSITY DR # C209
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5317
Practice Address - Country:US
Practice Address - Phone:954-406-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT42909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist