Provider Demographics
NPI:1215017090
Name:SANCHEZ, CASSIDY ANNE (PT)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:ANNE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:ANNE
Other - Last Name:COGGON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:51901 CTY HWY F
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:WI
Mailing Address - Zip Code:54634
Mailing Address - Country:US
Mailing Address - Phone:608-489-3577
Mailing Address - Fax:608-489-8193
Practice Address - Street 1:400 WATER AVE
Practice Address - Street 2:ST JOSEPHS REHAB DEPARTMENT
Practice Address - City:HILLSBORO
Practice Address - State:WI
Practice Address - Zip Code:54634
Practice Address - Country:US
Practice Address - Phone:608-489-8260
Practice Address - Fax:608-489-8193
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9543024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40475500Medicaid
WI625762OtherDPI