Healthcare Provider Details

I. General information

NPI: 1932702669
Provider Name (Legal Business Name): CASSANDRA J. CYR MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSIE CYR

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 MAIN ST
KEENE NH
03435-0001
US

IV. Provider business mailing address

21 MORIN AVE
KEENE NH
03431-1532
US

V. Phone/Fax

Practice location:
  • Phone: 603-358-2149
  • Fax: 603-358-2888
Mailing address:
  • Phone: 603-303-6639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1498
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: