Provider Demographics
NPI:1518072180
Name:DAN L. CASSADY
Entity Type:Organization
Organization Name:DAN L. CASSADY
Other - Org Name:MARIPOSA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PT
Authorized Official - Prefix:PROF
Authorized Official - First Name:DAN
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:CASSADY
Authorized Official - Suffix:
Authorized Official - Credentials:PT MTC
Authorized Official - Phone:209-742-7272
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 ST
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT10190OtherBLUE SHIELD
CA056619Medicare ID - Type Unspecified