Provider Demographics
NPI:1003245523
Name:CASSIDY, GILES (RCP/CRT)
Entity Type:Individual
Prefix:MR
First Name:GILES
Middle Name:
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:RCP/CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 N 28TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-1104
Mailing Address - Country:US
Mailing Address - Phone:971-570-0437
Mailing Address - Fax:
Practice Address - Street 1:1400 E SOUTHERN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5691
Practice Address - Country:US
Practice Address - Phone:866-308-2700
Practice Address - Fax:888-438-0350
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0875227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified