Provider Demographics
NPI:1538879234
Name:BERECZKY, CASSANDRA NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:NICOLE
Last Name:BERECZKY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7935 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45344-8269
Mailing Address - Country:US
Mailing Address - Phone:937-408-3027
Mailing Address - Fax:
Practice Address - Street 1:102 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:OH
Practice Address - Zip Code:45344-1417
Practice Address - Country:US
Practice Address - Phone:937-408-3027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026112225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist