Provider Demographics
NPI:1487137519
Name:SHRIVER, CASSANDRA LEE
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:SHRIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 N.P.I.D. APT# 17107
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78408
Mailing Address - Country:US
Mailing Address - Phone:361-946-0470
Mailing Address - Fax:
Practice Address - Street 1:2735 AIRLINE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3306
Practice Address - Country:US
Practice Address - Phone:361-992-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2131817225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant