MEDICARE: CASSIDY DALBERG

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	225200000X	Physical Therapy Assistant	PTA31396	FL

General Provider Information

NPI Number	:	1912661729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY DALBERG

Provider Business Mailing Address
First Line	:	5718 NE 17TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33334-5983
Country	:	US
Telephone Number	:	954-560-5681
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 W SAMPLE RD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33064-3542
Country	:	US
Telephone Number	:	954-942-5530
Fax Number	:

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

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	10/27/2021

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Directions to “ CASSIDY DALBERG ” Practice Location

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