Healthcare Provider Details

I. General information

NPI: 1104170588
Provider Name (Legal Business Name): JAMES H. CASSELL IV PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N GREENWICH RD
ARMONK NY
10504
US

IV. Provider business mailing address

300 BROAD ST APT 903
STAMFORD CT
06901-2162
US

V. Phone/Fax

Practice location:
  • Phone: 914-202-0700
  • Fax: 914-462-3444
Mailing address:
  • Phone: 914-413-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number035099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: