Provider Demographics
NPI:1992343701
Name:COLE, CASSAUNDRA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:CASSAUNDRA
Middle Name:LYNN
Last Name:COLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 BEAVER DAMS MORELAND RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAMS
Mailing Address - State:NY
Mailing Address - Zip Code:14812-9434
Mailing Address - Country:US
Mailing Address - Phone:607-426-4275
Mailing Address - Fax:
Practice Address - Street 1:600 ROE AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1629
Practice Address - Country:US
Practice Address - Phone:607-737-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist