Healthcare Provider Details

I. General information

NPI: 1912250028
Provider Name (Legal Business Name): CASSONDRA SACKE CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W 120TH AVE STE A
BROOMFIELD CO
80020-2824
US

IV. Provider business mailing address

2100 W 100TH AVE LOT 175
THORNTON CO
80260-5915
US

V. Phone/Fax

Practice location:
  • Phone: 303-451-6706
  • Fax:
Mailing address:
  • Phone: 303-960-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10081
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: