Provider Demographics
NPI:1659056323
Name:MANGAN, CASSIDY ERIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:ERIN
Last Name:MANGAN
Suffix:
Gender:F
Credentials:PT, DPT
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 33
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-0033
Mailing Address - Country:US
Mailing Address - Phone:219-916-7612
Mailing Address - Fax:
Practice Address - Street 1:2311 W 22ND ST STE 110
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1261
Practice Address - Country:US
Practice Address - Phone:630-912-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist