Healthcare Provider Details

I. General information

NPI: 1588286934
Provider Name (Legal Business Name): KASSANDRA MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 ASHEVILLE HWY
HENDERSONVILLE NC
28791-2305
US

IV. Provider business mailing address

65 LOOKOUT RD APT A2
ASHEVILLE NC
28804-3234
US

V. Phone/Fax

Practice location:
  • Phone: 828-693-8128
  • Fax:
Mailing address:
  • Phone: 518-817-2759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15021
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: