Provider Demographics
NPI:1578770277
Name:CASSIDY, DANIEL TIMOTHY (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:TIMOTHY
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8941 BOWER LN
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-5001
Mailing Address - Country:US
Mailing Address - Phone:858-735-8606
Mailing Address - Fax:
Practice Address - Street 1:1338 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2127
Practice Address - Country:US
Practice Address - Phone:760-789-1400
Practice Address - Fax:760-789-1401
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA157602251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports