Healthcare Provider Details

I. General information

NPI: 1760216030
Provider Name (Legal Business Name): CASSANDRA CROWELL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CASSANDRA PERALES

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 CAMINO COYOTE
LAS CRUCES NM
88011-7096
US

IV. Provider business mailing address

4151 CAMINO COYOTE
LAS CRUCES NM
88011-7096
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-0484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT-2024-0255
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: