Provider Demographics
NPI:1760046338
Name:CROTTY, CASSANDRA (PTA)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:CROTTY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:211 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2859
Mailing Address - Country:US
Mailing Address - Phone:319-277-3166
Mailing Address - Fax:319-266-4846
Practice Address - Street 1:211 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2859
Practice Address - Country:US
Practice Address - Phone:319-277-3166
Practice Address - Fax:319-266-4846
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093523225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1780687939Medicaid