Provider Demographics
NPI:1396196424
Name:YOUNG, CASSANDRA (PT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E FM 2410 RD
Mailing Address - Street 2:STE D
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-6898
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:2835 N GRANDVIEW BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5546
Practice Address - Country:US
Practice Address - Phone:262-574-1100
Practice Address - Fax:262-574-5193
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1306320225100000X
WI13469-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400316942Medicare PIN