Provider Demographics
NPI:1972482792
Name:BERNAICHE, CASSANDRA LEE (PTA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:BERNAICHE
Suffix:
Gender:X
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 LAKESHORE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-6772
Mailing Address - Country:US
Mailing Address - Phone:517-375-3017
Mailing Address - Fax:
Practice Address - Street 1:397 LAKESHORE POINTE DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-6772
Practice Address - Country:US
Practice Address - Phone:517-375-3017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004743225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant