Basic Information
| Provider Information | |||||||||
| NPI: | 1487137519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHRIVER | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2240 N.P.I.D. APT# 17107 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619460470 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2735 AIRLINE RD | ||||||||
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| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784143306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619920816 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2018 | ||||||||
| LastUpdateDate: | 09/14/2018 | ||||||||
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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 | 225200000X | 2131817 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.