Provider Demographics
NPI:1811123185
Name:DOCKINS, CASSANDRA (PTA)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:
Last Name:DOCKINS
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 1:3 ERIE CT
Mailing Address - Street 2:2 SOUTH OUTPATIENT PHYSICAL THERAPY
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2519
Mailing Address - Country:US
Mailing Address - Phone:708-763-1318
Mailing Address - Fax:708-383-1029
Practice Address - Street 1:3 ERIE CT
Practice Address - Street 2:2 SOUTH OUTPATIENT PHYSICALTHERAPY
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2519
Practice Address - Country:US
Practice Address - Phone:708-763-1318
Practice Address - Fax:708-383-1029
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160003335225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL160003335OtherPTA STATE OF ILLINOIS LICENSE NO