Provider Demographics
NPI:1841889474
Name:CASSO, ARIEL B (LPTA)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:B
Last Name:CASSO
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 AUSTRIAN PINE DR
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-9729
Mailing Address - Country:US
Mailing Address - Phone:804-832-3352
Mailing Address - Fax:
Practice Address - Street 1:1620 MIDTOWN PL
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6347
Practice Address - Country:US
Practice Address - Phone:405-397-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3175225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant