Healthcare Provider Details

I. General information

NPI: 1750484358
Provider Name (Legal Business Name): BRENDA L RASBERRY - CASSELBERRY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRENDA L CASSELBERRY DPM

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 EXECUTIVE PARK DRIVE
OPELIKA AL
36801
US

IV. Provider business mailing address

P O BOX 1268
AUBURN AL
36831
US

V. Phone/Fax

Practice location:
  • Phone: 334-705-0544
  • Fax: 334-705-0548
Mailing address:
  • Phone: 334-705-0544
  • Fax: 334-705-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number132
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number132
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: