Healthcare Provider Details

I. General information

NPI: 1336393925
Provider Name (Legal Business Name): KASSANDRA MAPEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2008
Last Update Date: 11/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LANTER CT
COLLINSVILLE IL
62234-6124
US

IV. Provider business mailing address

109 LANTER CT
COLLINSVILLE IL
62234-6124
US

V. Phone/Fax

Practice location:
  • Phone: 618-343-1122
  • Fax: 618-343-1444
Mailing address:
  • Phone: 618-343-1122
  • Fax: 618-343-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070016794
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: