MEDICARE: CASSANDRA TESS PHEA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1740452861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA TESS PHEA

Provider Business Mailing Address
First Line	:	4819 PILGRIM HARBOR DR
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-2962
Country	:	US
Telephone Number	:	281-788-0381
Fax Number	:	281-648-1997

Provider Business Practice Location Address
First Line	:	4819 PILGRIM HARBOR DR
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-2962
Country	:	US
Telephone Number	:	281-788-0381
Fax Number	:	281-648-1997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/28/2008

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Directions to “ CASSANDRA TESS PHEA ” Practice Location

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