Provider Demographics
NPI:1336864586
Name:HARRIS-KINNICK, CASSIE E (DPT)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:E
Last Name:HARRIS-KINNICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 E WARNER RD STE 121
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3445
Mailing Address - Country:US
Mailing Address - Phone:480-306-6627
Mailing Address - Fax:
Practice Address - Street 1:1840 E WARNER RD STE 121
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3445
Practice Address - Country:US
Practice Address - Phone:480-306-6627
Practice Address - Fax:480-306-6696
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist