Provider Demographics
NPI:1538361589
Name:HOLBERT, CASSONDRA DEE (LPTA)
Entity type:Individual
Prefix:MS
First Name:CASSONDRA
Middle Name:DEE
Last Name:HOLBERT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 LONG ST APT 813
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-9326
Mailing Address - Country:US
Mailing Address - Phone:740-983-9497
Mailing Address - Fax:
Practice Address - Street 1:800 LONG ST APT 813
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103-9326
Practice Address - Country:US
Practice Address - Phone:740-983-9497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 5306225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant