Provider Demographics
NPI:1023209962
Name:COLE, CASSI LEE (MPT)
Entity Type:Individual
Prefix:MISS
First Name:CASSI
Middle Name:LEE
Last Name:COLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6640 OSAGE TRL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-3210
Mailing Address - Country:US
Mailing Address - Phone:214-770-0343
Mailing Address - Fax:
Practice Address - Street 1:3033 W GEORGE BUSH HWY STE 150
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5752
Practice Address - Country:US
Practice Address - Phone:972-390-7733
Practice Address - Fax:972-390-7738
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11755982251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX854T75OtherBCBS ORTHOTEXAS
TXP00954311OtherRAILROAD MEDICARE
TXTXB119301OtherMEDICARE PIN
TX1175598OtherPHYSICAL THERAPY LICENSE
TX1K9617OtherMEDICARE