Healthcare Provider Details

I. General information

NPI: 1669145074
Provider Name (Legal Business Name): CASSANDRA ROSE RUBINO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N MILLER RD STE 150A
FAIRLAWN OH
44333-3713
US

IV. Provider business mailing address

7945 GLENGATE DR
BROADVIEW HEIGHTS OH
44147-1768
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-2240
  • Fax:
Mailing address:
  • Phone: 440-679-9114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberCOND.20211705-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: