Provider Demographics
NPI:1336622612
Name:MCCULLY, CASSANDRA RAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RAE
Last Name:MCCULLY
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 1:860 OXLEY RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3708
Mailing Address - Country:US
Mailing Address - Phone:330-704-8980
Mailing Address - Fax:
Practice Address - Street 1:3773 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3425
Practice Address - Country:US
Practice Address - Phone:614-566-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH016153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist