Basic Information
| Provider Information | |||||||||
| NPI: | 1306987680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWERS | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1003 LOGGERHEAD CT | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347445931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075521615 | ||||||||
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| Practice Location | |||||||||
| Address1: | 311 W BASS ST | ||||||||
| Address2: | |||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347415011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078705959 | ||||||||
| FaxNumber: | 4079336468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AL#1942 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.