Healthcare Provider Details

I. General information

NPI: 1962382002
Provider Name (Legal Business Name): CASSANDRA ROSE WOOLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 N LINCOLN AVE
CHICAGO IL
60657-1195
US

IV. Provider business mailing address

2138 WEST WEBSTER AVENUE 1F
CHICAGO IL
60647
US

V. Phone/Fax

Practice location:
  • Phone: 773-360-7287
  • Fax:
Mailing address:
  • Phone: 734-686-5039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.029480
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: