Provider Demographics
NPI:1376091827
Name:HOGAN, CASSANDRA BRUEY (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:BRUEY
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:MARY
Other - Last Name:BRUEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1127 NIKKI VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4879
Mailing Address - Country:US
Mailing Address - Phone:813-571-7184
Mailing Address - Fax:813-654-4695
Practice Address - Street 1:3000 MEDICAL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4695
Practice Address - Country:US
Practice Address - Phone:813-879-8046
Practice Address - Fax:855-388-5356
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist