Provider Demographics
NPI:1992101430
Name:WOODROW, CASSIE LEE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CASSIE
Middle Name:LEE
Last Name:WOODROW
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:CASSIE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:524 MAJORCA LOOP
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-8004
Mailing Address - Country:US
Mailing Address - Phone:540-421-0399
Mailing Address - Fax:
Practice Address - Street 1:198 VILLAGE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6618
Practice Address - Country:US
Practice Address - Phone:843-652-8273
Practice Address - Fax:843-652-8274
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7586225100000X
OHPT017797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist