Provider Demographics
NPI:1629084389
Name:HAGUE, CASSIE JEANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:JEANNE
Last Name:HAGUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:CASSIE
Other - Middle Name:JEANNE
Other - Last Name:PENDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3852 E BRIDGEPORT PKWY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-3675
Mailing Address - Country:US
Mailing Address - Phone:480-292-9359
Mailing Address - Fax:
Practice Address - Street 1:2940 E BANNER GATEWAY DR STE 200-250
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2168
Practice Address - Country:US
Practice Address - Phone:602-648-5444
Practice Address - Fax:602-772-3801
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ38328Medicare UPIN
AZ101734Medicare ID - Type UnspecifiedMEDICAL ID NUMBER