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General NPI Number Information
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NPI Number | 1922575562
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Entity Type | Individual
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Provider Name | CASANDRE WORSDORFER M.S. ATC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 11/01/2018
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Provider Practice Location Address
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Address Line | 123 PRESIDIO POINTE
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City | CHARLESTON
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State | WV
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Zip | 25313-1591
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Country | US
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Telephone | 570-460-5746
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Fax |
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Provider Business Mailing Address
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Address Line | 123 PRESIDIO POINTE
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City | CHARLESTON
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State | WV
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Zip | 25313-1591
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Country | US
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Telephone | 570-460-5746
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT004764
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT001507
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License Number State | WV
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