Provider Demographics
NPI:1639717762
Name:ONDECK, CASSONDRA (DPT)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:
Last Name:ONDECK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 BURGDORF DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2321
Mailing Address - Country:US
Mailing Address - Phone:215-591-9966
Mailing Address - Fax:
Practice Address - Street 1:PAUL'S RUN RETIREMENT COMMUNITY
Practice Address - Street 2:9896 BUSTLETON AVE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115
Practice Address - Country:US
Practice Address - Phone:877-318-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist