Healthcare Provider Details

I. General information

NPI: 1982256830
Provider Name (Legal Business Name): CASSIE ENDSLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4135 RICHARD AVE STE 102
HERMANTOWN MN
55811-2979
US

IV. Provider business mailing address

1939 MINNEHAHA AVE W STE 300
SAINT PAUL MN
55104-1033
US

V. Phone/Fax

Practice location:
  • Phone: 218-206-7775
  • Fax: 218-206-7776
Mailing address:
  • Phone: 651-748-4338
  • Fax: 651-748-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2151
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12874
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: