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General NPI Number Information
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NPI Number | 1306431788
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Entity Type | Individual
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Provider Name | KATHLEEN CASSIDY LMT
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Gender | Female
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Dates
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Enumeration Date | 03/07/2021
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Last Update Date | 03/07/2021
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Provider Practice Location Address
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Address Line | 28960 US HIGHWAY 19 N STE 112
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City | CLEARWATER
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State | FL
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Zip | 33761-2403
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Country | US
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Telephone | 727-992-0253
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Fax |
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Provider Business Mailing Address
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Address Line | 5548 MONTANA AVE
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-2644
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Country | US
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Telephone | 727-992-0253
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA55570
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License Number State | FL
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