Provider Demographics
NPI:1083997803
Name:CROTTS, CASSANDRA LEE (DPT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEE
Last Name:CROTTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLLEGE AVE STE G200
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2934
Mailing Address - Country:US
Mailing Address - Phone:785-539-9669
Mailing Address - Fax:785-539-9779
Practice Address - Street 1:1642 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6222
Practice Address - Country:US
Practice Address - Phone:620-342-7525
Practice Address - Fax:620-342-7588
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist