Provider Demographics
NPI:1972519593
Name:COMO, CASSANDRA LEIGH (PT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEIGH
Last Name:COMO
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 1:1251 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5050
Mailing Address - Country:US
Mailing Address - Phone:860-347-4426
Mailing Address - Fax:860-704-5998
Practice Address - Street 1:1251 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5050
Practice Address - Country:US
Practice Address - Phone:860-347-4426
Practice Address - Fax:860-704-5998
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080007327CT05OtherBLUE CROSS BLUE SHIELD