Provider Demographics
NPI:1376860064
Name:COOLEY, CASSY M (DPT)
Entity type:Individual
Prefix:
First Name:CASSY
Middle Name:M
Last Name:COOLEY
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 1:3101 WAUCHEETA TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5989
Mailing Address - Country:US
Mailing Address - Phone:608-222-3688
Mailing Address - Fax:
Practice Address - Street 1:313 STOUGHTON RD
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-1132
Practice Address - Country:US
Practice Address - Phone:608-884-1390
Practice Address - Fax:608-884-1393
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11250-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist