Provider Demographics
NPI:1811087265
Name:CASSELL, STEWART
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:CASSELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S BROADWAY STE 203
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6682
Mailing Address - Country:US
Mailing Address - Phone:805-922-1711
Mailing Address - Fax:805-858-6828
Practice Address - Street 1:150 S MARY AVE STE 1
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-7821
Practice Address - Country:US
Practice Address - Phone:805-929-3230
Practice Address - Fax:805-929-3232
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689606469OtherPHYSICAL EDGE, INC.
CA1770675639OtherPHYSICAL EDGE, INC.