Provider Demographics
NPI:1154642213
Name:DIAMOND, CASSANDRA JO (DPT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JO
Last Name:DIAMOND
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 1:37 METZ RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-8913
Mailing Address - Country:US
Mailing Address - Phone:307-751-1174
Mailing Address - Fax:
Practice Address - Street 1:1045 COFFEEN AVE STE C
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5388
Practice Address - Country:US
Practice Address - Phone:307-751-1174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist