Healthcare Provider Details

I. General information

NPI: 1992764104
Provider Name (Legal Business Name): KEVIN JAMES CASSIDY P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4358 FERGUSON DR SUITE 200
CINCINNATI OH
45245-1680
US

IV. Provider business mailing address

752 MENDON HILL LN
CINCINNATI OH
45244-5023
US

V. Phone/Fax

Practice location:
  • Phone: 513-943-4400
  • Fax: 513-943-5323
Mailing address:
  • Phone: 513-831-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006414
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: