Healthcare Provider Details

I. General information

NPI: 1740963503
Provider Name (Legal Business Name): TRAVIS M MCCASSEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MOUNTAIN ROAD 2ND FLOOR
SUFFIELD CT
06078
US

IV. Provider business mailing address

435 HARTFORD TPKE STE U
VERNON CT
06066-4834
US

V. Phone/Fax

Practice location:
  • Phone: 860-668-9589
  • Fax: 860-668-9802
Mailing address:
  • Phone: 860-668-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14086
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: