MEDICARE: MR. GILES CASSIDY RCP/CRT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	227800000X	Certified Respiratory Therapist	0875	AZ

General Provider Information

NPI Number	:	1003245523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GILES CASSIDY RCP/CRT

Provider Business Mailing Address
First Line	:	2811 N 28TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-1104
Country	:	US
Telephone Number	:	971-570-0437
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E SOUTHERN AVE
Second Line	:	SUITE 310
City	:	TEMPE
State	:	AZ
Zip	:	85282-5691
Country	:	US
Telephone Number	:	866-308-2700
Fax Number	:	888-438-0350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	11/05/2013

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