Healthcare Provider Details

I. General information

NPI: 1316902364
Provider Name (Legal Business Name): LINDA MARIE CASSIDY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7695 BEECHMONT AVE
CINCINNATI OH
45255-4216
US

IV. Provider business mailing address

4440 GLEN ESTE WITHAMSVILLE RD STE 1500
CINCINNATI OH
45245-1335
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-1847
  • Fax: 513-232-2491
Mailing address:
  • Phone: 513-753-2133
  • Fax: 513-753-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT007337
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: