Provider Demographics
NPI:1124008990
Name:CASSENS, JONATHAN (CPO, LPO)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:CASSENS
Suffix:
Gender:M
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 E VILLA MARIA RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2542
Mailing Address - Country:US
Mailing Address - Phone:979-731-1985
Mailing Address - Fax:979-776-8447
Practice Address - Street 1:2112 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2542
Practice Address - Country:US
Practice Address - Phone:979-731-1985
Practice Address - Fax:979-776-8447
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138222Z00000X, 224P00000X
TX102390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Not Answered224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO01811OtherBOARD CERTIFICATION, ABC
TX515099OtherBCBS PROVIDER ID
TX22102OtherSCOTT AND WHITE PROV ID
TX22102OtherSCOTT AND WHITE PROV ID