Provider Demographics
NPI:1962261925
Name:VENTRELLA, CASSANDRA MAE (LMT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MAE
Last Name:VENTRELLA
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 1:2772 KALMIA ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1853
Mailing Address - Country:US
Mailing Address - Phone:541-971-8701
Mailing Address - Fax:
Practice Address - Street 1:1200 EXECUTIVE PKWY STE 230
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2365
Practice Address - Country:US
Practice Address - Phone:541-636-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT24647225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist