Healthcare Provider Details

I. General information

NPI: 1295809226
Provider Name (Legal Business Name): CASSANDRA LIEBERMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18425 LONG LAKE DR
BOCA RATON FL
33496-1934
US

IV. Provider business mailing address

18425 LONG LAKE DR
BOCA RATON FL
33496-1934
US

V. Phone/Fax

Practice location:
  • Phone: 561-706-8020
  • Fax: 561-487-0087
Mailing address:
  • Phone: 561-706-8020
  • Fax: 561-487-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: