Provider Demographics
NPI:1164760641
Name:CASSINERIO, JOHN FRANK (LMP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANK
Last Name:CASSINERIO
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19839 HIGHWAY 213 APT A2004
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7946
Mailing Address - Country:US
Mailing Address - Phone:360-593-3586
Mailing Address - Fax:
Practice Address - Street 1:619 HIGH ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2240
Practice Address - Country:US
Practice Address - Phone:503-656-4993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60254453172M00000X
OR20616172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist