Basic Information
| Provider Information | |||||||||
| NPI: | 1053352336 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEWART | ||||||||
| FirstName: | CASSIE | ||||||||
| MiddleName: | GASKINS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | A.T.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 GARTON RD | ||||||||
| Address2: | |||||||||
| City: | BURNS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370295214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154460839 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1696 FAIRVIEW BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FAIRVIEW | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370625137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157991915 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 0000000592 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.