Provider Demographics
NPI:1427020841
Name:CASS, TIMOTHY B (RPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:B
Last Name:CASS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19416 473RD AVE
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:SD
Mailing Address - Zip Code:57268-5705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 3RD AVE S
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:SD
Practice Address - Zip Code:57226-2016
Practice Address - Country:US
Practice Address - Phone:605-874-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist