Provider Demographics
NPI:1407292055
Name:CULPEPPER, CASSI BETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:CASSI
Middle Name:BETH
Last Name:CULPEPPER
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 1:1509 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2700
Mailing Address - Country:US
Mailing Address - Phone:229-425-4578
Mailing Address - Fax:
Practice Address - Street 1:2401 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4806
Practice Address - Country:US
Practice Address - Phone:954-943-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 28138225100000X
GAPT 010785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist