Provider Demographics
NPI:1689822496
Name:BUTTS, CASSANDRA BRIANNE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:BRIANNE
Last Name:BUTTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:BRIANNE
Other - Last Name:ANIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5152 KATELLA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2843
Mailing Address - Country:US
Mailing Address - Phone:562-431-6004
Mailing Address - Fax:562-431-9854
Practice Address - Street 1:5152 KATELLA AVE STE 106
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2843
Practice Address - Country:US
Practice Address - Phone:562-431-6004
Practice Address - Fax:562-431-9854
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34758225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS960YMedicare UPIN