Healthcare Provider Details

I. General information

NPI: 1518875822
Provider Name (Legal Business Name): CASSIDY DUNHAM LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSIDY ROBERTS LMT

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15158 NEWBERRY LN
FOLEY AL
36535-5279
US

IV. Provider business mailing address

15158 NEWBERRY LN
FOLEY AL
36535-5279
US

V. Phone/Fax

Practice location:
  • Phone: 607-206-2530
  • Fax:
Mailing address:
  • Phone: 607-206-2530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number50249
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: