Provider Demographics
NPI:1891477907
Name:PHILLIPS, CASSIDY PAIGE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:PAIGE
Last Name:PHILLIPS
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 1:648 W PENN ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2932
Mailing Address - Country:US
Mailing Address - Phone:516-776-3355
Mailing Address - Fax:
Practice Address - Street 1:648 W PENN ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2932
Practice Address - Country:US
Practice Address - Phone:516-776-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist