Provider Demographics
NPI:1932079175
Name:BRISTER, CASSIE THOMPSON (PT)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:THOMPSON
Last Name:BRISTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1058 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-9121
Mailing Address - Country:US
Mailing Address - Phone:601-650-0002
Mailing Address - Fax:601-650-9902
Practice Address - Street 1:13010 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:MS
Practice Address - Zip Code:39154-8900
Practice Address - Country:US
Practice Address - Phone:601-857-2229
Practice Address - Fax:601-857-8223
Is Sole Proprietor?:No
Enumeration Date:2025-11-11
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT7941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist