Healthcare Provider Details

I. General information

NPI: 1215255914
Provider Name (Legal Business Name): CASSANDRE ANN BUCKALEW L.C.M.T., C.M.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 SANDY DR
HENDERSON NV
89002-9223
US

IV. Provider business mailing address

640 SANDY DRIVE
HENDERSON NV
89002-9223
US

V. Phone/Fax

Practice location:
  • Phone: 702-769-0655
  • Fax: 702-566-0473
Mailing address:
  • Phone: 702-769-0655
  • Fax: 702-566-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNV4153
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: