Provider Demographics
NPI:1265777841
Name:DENHARTOG, CASSANDRA (PTA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:DENHARTOG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 130TH PL
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138
Mailing Address - Country:US
Mailing Address - Phone:641-218-0338
Mailing Address - Fax:
Practice Address - Street 1:1828 130TH PL
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-8704
Practice Address - Country:US
Practice Address - Phone:641-218-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004966225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant