Healthcare Provider Details

I. General information

NPI: 1205207479
Provider Name (Legal Business Name): CASSANDRA BODY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 GROVE PARK DR APT 1704
COLUMBUS GA
31904-1599
US

IV. Provider business mailing address

2850 W HORIZON RIDGE PKWY STE 200
HENDERSON NV
89052-4395
US

V. Phone/Fax

Practice location:
  • Phone: 334-744-1137
  • Fax:
Mailing address:
  • Phone: 702-900-9853
  • Fax: 702-577-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number4990G
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4990G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: