MEDICARE: MRS. CASSIDY EVANS

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	225700000X	Massage Therapist	MT135883	TX

General Provider Information

NPI Number	:	1912619248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASSIDY EVANS

Provider Business Mailing Address
First Line	:	11325 IH 37 APT 1502
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-3342
Country	:	US
Telephone Number	:	361-281-3428
Fax Number	:	361-491-6007

Provider Business Practice Location Address
First Line	:	11325 IH 37 APT 1502
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78410-3342
Country	:	US
Telephone Number	:	361-281-3428
Fax Number	:	361-491-6007

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

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	04/29/2026

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