Provider Demographics
NPI:1437218096
Name:CASSADY, DAN LEON (PT, MTC)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:LEON
Last Name:CASSADY
Suffix:
Gender:M
Credentials:PT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0069
Mailing Address - Country:US
Mailing Address - Phone:209-742-7272
Mailing Address - Fax:209-742-7368
Practice Address - Street 1:5072 BULLION STREET
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338
Practice Address - Country:US
Practice Address - Phone:209-742-7272
Practice Address - Fax:209-742-7368
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALOPT010190OtherBLUE SHIELD
CA056619Medicare ID - Type Unspecified