Healthcare Provider Details

I. General information

NPI: 1003245523
Provider Name (Legal Business Name): GILES CASSIDY RCP/CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E SOUTHERN AVE SUITE 310
TEMPE AZ
85282-5691
US

IV. Provider business mailing address

2811 N 28TH ST
PHOENIX AZ
85008-1104
US

V. Phone/Fax

Practice location:
  • Phone: 866-308-2700
  • Fax: 888-438-0350
Mailing address:
  • Phone: 971-570-0437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number0875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: