Provider Demographics
NPI:1790080737
Name:CASSIDY, DIRON REESE (MPT)
Entity Type:Individual
Prefix:MR
First Name:DIRON
Middle Name:REESE
Last Name:CASSIDY
Suffix:
Gender:M
Credentials:MPT
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Mailing Address - Street 1:3150 ALMADEN EXPY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1260
Mailing Address - Country:US
Mailing Address - Phone:408-540-7622
Mailing Address - Fax:408-540-7696
Practice Address - Street 1:3150 ALMADEN EXPY
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1260
Practice Address - Country:US
Practice Address - Phone:408-540-7622
Practice Address - Fax:408-540-7696
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2017-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA26803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist