Provider Demographics
NPI:1275649931
Name:IVES, RENEE MARIE CASSIDY (PT)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MARIE CASSIDY
Last Name:IVES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:MARIE
Other - Last Name:CASSIDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8675 WELLER RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45249-3422
Mailing Address - Country:US
Mailing Address - Phone:504-239-2912
Mailing Address - Fax:
Practice Address - Street 1:4815 COOPER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6993
Practice Address - Country:US
Practice Address - Phone:513-891-0934
Practice Address - Fax:513-891-1323
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT011466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4189941Medicare PIN