Provider Demographics
NPI:1053352336
Name:STEWART, CASSIE GASKINS (ATC)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:GASKINS
Last Name:STEWART
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 GARTON RD
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:TN
Mailing Address - Zip Code:37029-5214
Mailing Address - Country:US
Mailing Address - Phone:615-446-0839
Mailing Address - Fax:
Practice Address - Street 1:1696 FAIRVIEW BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-5137
Practice Address - Country:US
Practice Address - Phone:615-799-1915
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000005922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer